ROLE OF PLASTER OF PARIS CAST IMMOBILIZATION OF SKELETAL PIN FOLLOWING SKELETAL TRACTION ABSTRACT

Abstract

BACKGROUND: Application of skeletal traction, requires insertion of skeletal pin which inflicts an open skin wound around the pin, impending portal for entry of microbes into the pin tract. Associated notable complications are metal reactions and secondary infection, subsequently leads to pin change or removal, failure of fracture union, septic arthritis, osteomyelitis etc. Aim of the present study was to compare the pin tract infection grade of elderly patients having open pins with antiseptic dressing and cases immobilized with plaster of Paris (POP) cast.
 MATERIALS AND METHODS: The study population consists of 88 patients treated with upper tibial skeletal traction, of whom 44 persons followed up by regular antiseptic dressing of open percutaneous pin would (Group 1) and the rest 44 persons having pin covered with POP cast (Group 2). Pin tracts of both groups were evaluated after 6 weeks by Checketts-Otterburn’s grading system. Primary outcome variables of infection gradation and outcome measures was compared by NNT with 95% confidence interval, proportion and percentage.
 RESULTS: Mean age of patients of group 1 was 69.75, SD 7.185 and group 2 was 68.95, SD 8.177. Skeletal pin had to be removed (Grade 4 in Checketts-Otterburn’s grading system) in 10 (66.7%) of group 1 compared to only 5 (33.3%) cases of group 2. No case of osteomyelitis (Grade 6) has been seen in any group. The difference in grade of pin tract infection in the two groups was statistically significant (p =0.001).
 DISCUSSION
 High morbidity in conservative treatment is vastly the result of continuous pain, infection and discomfort. The present study compellingly documented non-operative management by skeletal traction is far from being the lethal procedure if the the rate of pin tract infection is reduced by covering with POP cast. In institutes that cater to a significant number of elderly population, skeletal traction with appropriate control of pin site infection is an effective alternative to more aggressive operative method.
 Keywords: Skeletal Traction, Pin Tract Infection, Elderly Patients, Plaster of Paris (Pop) Cast.