On the use of drains in orthopedic and trauma

Abstract

The use of drains in trauma and Orthopaedic practice has been affected by the concept of evidence based medicine that has become accepted as standard of care for all surgical or medical practice, which questions all care processes that cannot be backed by evidence to be beneficial to the patient. There have been a large number of multi centre meta-analytical studies that found drains to be of little or no benefit in trauma and Orthopaedic operations. Because of these studies, there are few situations where drains are routinely used e.g. Calcaneal fractures in developed countries. Even major procedures like total knee and arthroplasties are being performed without drains. We set to find out whether such evidence can be found in our practice. Between 2004 and 2012, eighty six patients matched for sex and type of injury and operative procedures to be done were prospectively selected and assigned to use or no use of drains in their operations. Complications like haematoma, drain migration, infection, inadvertent drain stitching were observed in the two groups. Eighty six major orthopaedic operations were studied. There was no evidence of occurrence of complication arising from non use of drains in the undrained group. Those patients whose wounds were drained had no need for drain change thus making the wound care less eventful Postoperative wound drains make for neat postoperative period with less tissue swelling. There was no statistically significant differences between the drained and undrained wounds in terms of infection rates, haematoma or seroma formation.