Adolescent experience with traumatic injury and orthopaedic external fixation: forever changed.

BACKGROUND: More than 13 million adolescents sustain traumatic injuries yearly, resulting in functional disability, disfigurement, psychosocial problems, and fractures that are increasingly treated with orthopaedic external fixation devices. Little is known about the experiences of injured adolescents. METHOD: This longitudinal, qualitative descriptive study described the experiences of traumatically injured adolescents treated with external fixation devices. RESULTS: Analysis of data from 26 open-ended, semistructured interviews with 5 male and 4 female adolescents revealed a struggle to return "to their old self" only to recognize that they were "forever changed." Major themes included what risk? (circumstances leading to the traumatic event), processing the event, suck it up and deal with it (strategies), space-age robot, and they'll do it themselves (pin care self-management). CONCLUSION: Their experiences affected all tasks of adolescence: independence from parents, accepting body image, peer relations, and forming an identity. Findings related to the use of self-administered analgesics, information technology, recall of detail, and gender differences in coping may lead to future interventions and lay the groundwork for future studies that may improve care of adolescents during acute recovery from traumatic injury.

Multicenter pin care study.

BACKGROUND: Pin-site infection is a common complication of external fixation. Because few studies have compared methods of pin care that reduce infection rate, there is a need for evidence-based practice guidelines for pin-site care. METHODS: Two of 10 original clinical centers completed a prospective, randomized pin-care study between May 2000 and May 2002 to determine which of seven methods for caring for skeletal pins (external fixator, traction, or halo) resulted in the fewest pin-site infections. RESULTS: The 92 subjects had an average infection rate of 34%, and the 527 pins had a rate of 20%. Thirty patients (98 pins) had stage II infections, two patients (12 pins) had stage III infections, and none had deep infection or osteomyelitis. The protocols were (1) half-strength peroxide cleansing and gauze wraps (45%), (2) half-strength peroxide cleansing and Xeroform wraps (9%), (3) saline cleansing and gauze wraps (33%), (4) saline cleansing and Xeroform wraps (26%), (5) antibacterial soap-and-water cleansing and gauze (38%), (6) antibacterial soap-and-water cleansing and Xeroform gauze (50%), and (7) stable dressings with no pin cleansing (36%). Logistic regression analysis demonstrated significant inverse relationships (p = .05) between infection rate and age, as well as fixator type; the latter may be related to exposed threads. CONCLUSION: Results suggest that other factors outside the realm of this study may affect children's pin-site infection rate and that half-strength peroxide and Xeroform dressings were superior to soap-and-water cleansing. This pilot study indicates a need for further research with a larger sample size and for exploring factors in a younger population.