Introduction. Irrigation and debridement of external fixator pin sites is one method utilized by orthopedic surgeons to prevent surgical site infections in patients undergoing definitive internal fixation after temporization in an external fixation device. This study aims to determine if irrigation and debridement of external fixator pin-sites leads to fewer deep surgical site infections, compared to simply scrubbing the external fixator pin sites with a chlorhexidine scrub-brush. Methods. This single center retrospective cohort study was performed at a University Level I Trauma Center. All cases in which a single surgeon removed an external fixator and followed this with definitive open reduction and internal fixation (ORIF) in the same operative setting between October 2007 and October 2018 were reviewed. 313 patients were temporized in 334 external fixators prior to ORIF and were included in the study. Results. 18 of the 179 Irrigation and Debridement cohort (10.0%) and 8 of the 155 Simple Scrubbing cohort (5.2%) resulted in infections that required return to the operating room. We found no statistical difference (p=0.10) or meaningful effect size (Cohen’s d= 0.18) between irrigation and debridement and simple scrubbing of external fixator pin-sites. Conclusions. Given no significant difference was found between debridement of pin sites versus simply scrubbing, the authors propose further studies should focus on the time and resources required for debriding external fixator pin sites.

Introduction. Opioids play a crucial role in post-operative pain management in America, but not in some other countries. We sought to determine if a discrepancy in opioid use between the United States (U.S.) and Romania, a country that administers opioids in a conservative fashion, would show in subjective pain control differences. Methods. Between May 23, 2019, and November 23, 2019, 244 Romanian patients and 184 American patients underwent total hip arthroplasty or the surgical treatment of the following fractures: bimalleolar ankle, distal radius, femoral neck, intertrochanteric, and tibial-fibular. Opioid and non-opioid analgesic medication use and subjective pain scores during the first and second 24 hours after surgery were analyzed. Results. Subjective pain scores for the first 24 hours were higher among patients in Romania compared to the U.S. (p < 0.0001), but Romanians reported lower pain scores than U.S. patients in the second 24-hours (p < 0.0001). The quantity of opioids given to U.S. patients did not differ significantly based on sex (p = 0.4258) or age (p = 0.0975). However, females reported higher pain scores than male patients following the studied procedures (p = 0.0181). No sex-based differences in pain scores were noted among Romanian patients. Conclusions. Higher pain scores in American females, despite equivalent amounts of narcotics to their male counterparts, and the absence of a difference in Romanians suggested that the current American post-operative pain regimen may be tailored to the needs of male patients. In addition, it pointed to the impacts of gender, compared to sex, in pain experiences. Future research should look for the safest, most efficacious pain regimen suitable for all patients.