Write a 10 pages paper on skeletal pin site management. External fixation is described as a surgical routine that drills holes into the uninjured areas of bones around the fracture and screw special bolts into the holes. This is done to set bone fractures in which a cast would not allow proper alignment of the fracture. A rod with special ball-and-socket joints joins the bolts to make a rigid support, is placed outside the body. By adjusting the ball-and-socket joints, the fracture can be set in the proper anatomical configuration. Compared to other types of cast used in fractured bones external fixation is used most frequently. This is because the patient will be able to mobilize earlier than other types of fixations which means, the patient will have to spend shorter time in the hospital. It was also observed that external fixations enables the patient to cope up early and perform almost all its normal activities.On the other hand, pin sites are locations on which pins are inserted into the hole created in the unfractured and soft bone. It serves as an entry and exit in the skin to provide skeletal traction or external fixation apparatus.Installation of external fixations, more often than not, developed pin site infections. Signs of reaction include changes in normal skin color, increased warmth, and serous or slightly bloody drainage at the pin site. Importantly, a pin site reaction is not a pin site infection. (Holmes and Brown, 2005) The swelling is a common reaction of the body’s tissue in the presence of foreign bodies such as pins. This will develop to pin site infection if not managed properly.With this, pin site management is practised by regularly checking the areas where the external fixators were attached and checking it for signs of infection such as tenting, redness, tenderness and purulent drainage. This also involves regular cleaning of the pin sites. However, different medical establishments apply different ways of cleaning. different procedures in cleansing, varied frequency and techniques for applying cleansing agent(s), removal of crusts, and use of dressings. In this research, procedures of skeletal pin site management are being studied to be able to evaluate and recommend the best and effective way in managing external fixations and pin tract infection. The goals are to keep swelling and pain caused by surgery to a low level, provide exercises to increase circulation and start wound (pin) care to prevent infection.Current ProcedureRoyal Darwin Hospital’s procedures in managing pin sites are as follows:Put a betadine gauze around the pin sites for 48hours.After 48 hours, removed the betadine gauze and leave the pins sites alone. These will not be cleaned to leave the crusts intact. If the pin sites become infected, they are cleaned through the direction of the consultant. This practise however, is in contrast of what Lisa Marie Bernardo has said in her article, Evidence-based Practice for Pin Site Care in Injured Children which says “there is a general agreement that pin sites of patients receiving external fixation should be inspected and cleansed to prevent infection. (Bernardo, October 2001)The fact that the pin sites were not cleaned after 48 hours to leave the crust intact will have a possibility of greater risk of infection.
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