• 1. Anderson GM, Lewis DD, Radasch RM, et al. Circular external skeletal fixation stabilization of antebrachial and crural fractures in 25 dogs. J Am Anim Hosp Assoc 2003;39:479498.

    • Search Google Scholar
    • Export Citation
  • 2. Antoci V, Ono CM, Antoci V, et al. Pin-tract infection during limb lengthening using external fixation. Am J Orthop 2008;37:E150E154.

  • 3. Mahan J, Seligson D, Henry SL, et al. Factors in pin tract infections. Orthopedics 1991;14:305308.

  • 4. Marsh JL, Mahoney CR, Steinbronn D. External fixation of open humerus fractures. Iowa Orthop J 1999;19:3542.

  • 5. Keating JF, Gardner E, Leach WJ, et al. Management of tibial fractures with the orthofix dynamic external fixator. J R Coll Surg Edinb 1991;36:272277.

    • Search Google Scholar
    • Export Citation
  • 6. Coester LM, Nepola JV, Allen J, et al. The effects of silver coated external fixation pins. Iowa Orthop J 2006;26:4853.

  • 7. Parameswaran AD, Roberts CS, Seligson D, et al. Pin tract infection with contemporary external fixation: how much of a problem? J Orthop Trauma 2003;17:503507.

    • Search Google Scholar
    • Export Citation
  • 8. Green SA, Ripley MJ. Chronic osteomyelitis in pin tracks. J Bone Joint Surg Am 1984;66:10921098.

  • 9. Moroni A, Vannini F, Mosca M, et al. State of the art review: techniques to avoid pin loosening and infection in external fixation. J Orthop Trauma 2002;16:189195.

    • Search Google Scholar
    • Export Citation
  • 10. Fox SM, Bray JC, Guerin SR, et al. Antebrachial deformities in the dog: treatment with external fixation. J Small Anim Pract 1995;36:315320.

    • Search Google Scholar
    • Export Citation
  • 11. Paley D. Problems, obstacles, and complications of limb lengthening by the Ilizarov technique. Clin Orthop Relat Res 1990;250:81104.

    • Search Google Scholar
    • Export Citation
  • 12. Ring D, Bruinsma WE, Jupiter JB. Complications of hinged external fixation compared with cross-pinning of the elbow for acute and subacute instability. Clin Orthop Relat Res 2014;472:20442048.

    • Search Google Scholar
    • Export Citation
  • 13. Harari J. Complications of external skeletal fixation. Vet Clin North Am Small Anim Pract 1992;22:99107.

  • 14. Johnson AL, Kneller SK, Weigel RM. Radial and tibial fracture repair with external skeletal fixation: effects of fracture type, reduction, and complications on healing. Vet Surg 1989;18:367372.

    • Search Google Scholar
    • Export Citation
  • 15. Knudsen CS, Arthurs GI, Hayes GM, et al. Long bone fracture as a complication following external skeletal fixation: 11 cases. J Small Anim Pract 2012;53:687692.

    • Search Google Scholar
    • Export Citation
  • 16. Marcellin-Little DJ, Ferretti A, Roe SC, et al. Hinged Ilizarov external fixation for correction of antebrachial deformities. Vet Surg 1998;27:231245.

    • Search Google Scholar
    • Export Citation
  • 17. Bland JM, Altman DG. Statistics notes: Cronbach's alpha. Br Med J (Clin Res Ed) 1997;314:572.

  • 18. Meijer PP, Karlsson J, LaPrade RF, et al. A guideline to medical photography: a perspective on digital photography in an orthopaedic setting. Knee Surg Sports Traumatol Arthrosc 2012;20:26062611.

    • Search Google Scholar
    • Export Citation
  • 19. Cavusoglu AT, Er MS, Inal S, et al. Pin site care during circular external fixation using two different protocols. J Orthop Trauma 2009;23:724730.

    • Search Google Scholar
    • Export Citation
  • 20. Chan CK, Saw A, Kwan MK, et al. Diluted povidone-iodine versus saline for dressing metal-skin interfaces in external fixation. J Orthop Surg (Hong Kong) 2009;17:1922.

    • Search Google Scholar
    • Export Citation
  • 21. Camathias C, Valderrabano V, Oberli H. Routine pin tract care in external fixation is unnecessary: a randomised, prospective, blinded controlled study. Injury 2012;43:19691973.

    • Search Google Scholar
    • Export Citation
  • 22. Camilo AM, Bongiovanni JC. Evaluation of effectiveness of 10% polyvinylpyrrolidone-iodine solution against infections in wire and pin holes for Ilizarov external fixators. Sao Paulo Med J 2005;123:5861.

    • Search Google Scholar
    • Export Citation
  • 23. Egol KA, Paksima N, Puopolo S, et al. Treatment of external fixation pins about the wrist: a prospective, randomized trial. J Bone Joint Surg Am 2006;88:349354.

    • Search Google Scholar
    • Export Citation
  • 24. Patterson MM. Multicenter pin care study. Orthop Nurs 2005;24:349360.

  • 25. Lee CK, Chua YP, Saw A. Antimicrobial gauze as a dressing reduces pin site infection: a randomized controlled trial. Clin Orthop Relat Res 2012;470:610615.

    • Search Google Scholar
    • Export Citation
  • 26. Davies R, Holt N, Nayagam S. The care of pin sites with external fixation. J Bone Joint Surg Br 2005;87:716719.

  • 27. van Laerhoven H, Zaag-Loonen HJ, Derkx B. A comparison of Likert scale and visual analogue scales as response options in children's questionnaires. Acta Paediatr 2004;93:830835.

    • Search Google Scholar
    • Export Citation
  • 28. Guyatt GH, Townsend M, Berman LB, et al. A comparison of Likert and visual analogue scales for measuring change in function. J Chronic Dis 1987;40:11291133.

    • Search Google Scholar
    • Export Citation
  • 29. Iacobucci D, Duhachek A. Advancing alpha: measuring reliability with confidence. J Consum Psychol 2003;13:478487.

  • 30. Holt J, Hertzberg B, Weinhold P, et al. Decreasing bacterial colonization of external fixation pins through nitric oxide release coatings. J Orthop Trauma 2011;25:432437.

    • Search Google Scholar
    • Export Citation
  • 31. Brånemark R, Berlin Ö, Hagberg K, et al. A novel osseointegrated percutaneous prosthetic system for the treatment of patients with transfemoral amputation. A prospective study of 51 patients. Bone Joint J 2014;96:106113.

    • Search Google Scholar
    • Export Citation
  • 32. Zopf Y, Konturek P, Nuernberger A, et al. Local infection after placement of percutaneous endoscopic gastrostomy tubes: a prospective study evaluating risk factors. Can J Gastroenterol 2008;22:987991.

    • Search Google Scholar
    • Export Citation

Advertisement

Assessment of an implant-skin interface scoring system for external skeletal fixation of dogs

View More View Less
  • 1 Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27606.
  • | 2 Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27606.
  • | 3 Center for Comparative Medicine and Translational Research, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27606.
  • | 4 Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27606.
  • | 5 Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27606.
  • | 6 Center for Comparative Medicine and Translational Research, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27606.
  • | 7 Veterinary Specialty Hospital of the Carolinas, 6405 Tryon Rd, Cary, NC 27518.
  • | 8 Department of Statistics, College of Agriculture and Life Sciences, North Carolina State University, Raleigh, NC 27695.

Abstract

OBJECTIVE To assess intraobserver repeatability and interobserver and in vivo versus photographic agreement of a scoring system for the implant-skin interface (ISI) of external skeletal fixation (ESF).

SAMPLE 42 photographs of ISIs from 18 dogs for interobserver agreement and intraobserver repeatability and 27 photographs of ISIs from 6 dogs for in vivo versus photograph agreement.

PROCEDURES An ISI inflammation scoring system was developed. It included scales for 6 metrics (erythema, drainage amount, drainage type, swelling, hair loss or lack of hair regrowth, and granulation tissue). Photographs of the ISI of ESF were obtained by use of a standard protocol and evaluated to determine intraobserver repeatability and interobserver agreement (Cronbach α; 4 raters) of the ISI score. Agreement between in vivo and photographic ISI scores (2 raters) and correlation between median scores across metrics were evaluated.

RESULTS 42 photographs met the inclusion criteria. Overall intraclass correlation coefficients ranged from 0.922 to 0.975. Interobserver overall Cronbach α ranged from 0.835 to 0.943. For in vivo versus photographic assessment, 27 ISIs in 6 dogs and their photographs were evaluated. The Cronbach α for both raters ranged from 0.614 to 0.938. Overall, the Cronbach α ranged from 0.725 to 0.932. Mean photographic scores were greater than mean in vivo scores for each metric. Pearson correlation coefficients ranged from 0.221 to 0.923. Erythema, swelling, and granulation were correlated with all other metrics.

CONCLUSIONS AND CLINICAL RELEVANCE In this study, an ISI scoring system used in this study had high repeatability and agreement and may therefore be considered for use in clinical situations. Photographic scores were not equivalent to in vivo scores and should not be used interchangeably.

Contributor Notes

Dr. McDonald-Lynch's present address is Veterinary Specialty Hospital of the Carolinas, 6405 Tryon Rd, Cary, NC 27518.

Address correspondence to Dr. Marcellin-Little (denis_marcellin@ncsu.edu).