Halo Skeletal Traction Pin Site Care: Toward Developing a Standard of Care

Abstract

Halo skeletal traction may be used to immobilize a patient's head and neck following a cervical fracture. Prevention of infectious reactions around the pin sites of halo traction is a priority in rehabilitation nursing practice. Although prophylactic treatment of skeletal pin sites is a generally accepted practice, there is great diversity of opinion and very limited systematic investigation as to how the sites should be treated. In this article, the author reviews the literature on pin site care and suggests a protocol based on the current literature.

No difference between daily and weekly pin site careA randomized study of 50 patients with external fixation

“…Daily pin site care by the patient or a district nurse is usually recommended (Meléndez and Colón 1989, Olson 1996, Sims and Saleh 1996, McKenzie 1999. In a pilot-study (unpublished data), we found no differences between daily and weekly pin site care.…”

Randomized Prospective Study on the Use of Eufiss in the Prevention of Infections in Patients Treated with External Fixation

“…The use of ionic silver as an antiseptic dates back to the early 900's and numerous studies have been published confirming its effective antimicrobial action even in antibiotic-resistant microbial populations (9,11,13). This property makes it particularly suitable for the treatment of subjects suffering from specific diseases ofthe immune system (20)(21).…”

“…Published data report the frequency of infections caused by external fixation which varies from 2 to 30%, with a predominance for superficial infections as opposed to deep ones (8)(9)(10). The most frequently isolated bacteria are Staphylococcus epidermidis, Staphylococcus aureus and Escherichia coli (11)(12)(13)(14).…”

Management of brain abscesses associated with halo fixation

“…Other cleansing agents traditionally used in routine pin care (povidone-iodine, hydrogen peroxide, chlorhexidine) may have a higher propensity to cause infection based on a sample of patients. 8 Excessive pin site cleansing can also be problematic and may lead to excess granulation tissue around the pins and subsequent loosening. 17 It is imperative to provide appropriate instructions regarding pin site hygiene, not only to the patient, but also to the caregiver, who will generally be the primary person involved in pin care and hygiene.…”

“…In the cases described in the literature, patients with cerebral abscesses have presented with a broad spectrum of symp-toms including but not limited to fever, headache, nausea, vomiting, seizure, aphasia, lethargy, meningismus, and psychosis. [1][2][3][4][5][6][7][8][9]11,12,[14][15][16][17] Early recognition is imperative because intravenous antibiotic treatment will be more effective at an earlier stage when only cerebritis is present. 17 Once the cerebritis progresses to actual abscess formation, a firm fibrous capsule forms containing necrotic material and debris that are resistant to intravenous antibiotic therapy.…”