External Fixator Pin Care – What They Don’t Tell You in The Hospital
I’ve been caring for my son’s external fixator for several months now. It’s been an experience to say the least and completing daily pin care from his surgery date until now has taught me a lot. There are many things I wasn’t told in the hopsital that I have learned along the way and want to pass onto anyone who is going to go through this or already going through an exernal fixator and looking for information.
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A bit of history. My now 6-year-old son has Ollier’s Disease. This non-genetic condition deforms bones with cartilaginous tumors and the large tumor in my son’s leg caused it to bow and be much shorter than the other leg. The day came to straighten and lengthen the bone and two external fixators were placed on the table before us. We didn’t know if our son would have the ring-like fixator or the one that sits to the site that he came out of surgery installed…for lack of a better word. We began preparing for the fixator surgery and counting down the days.
The first external fixator pin care we experienced was in the hospital. The next day, the Physical Therapist who was going to teach us how to do pin care, another PT, the surgeon and the pain team all stood bedside while the bandages were removed. I was unprepared for my son’s reaction. He had seen the fixator before surgery, we talked about him becoming Iron Man and I showed him photos online but his reaction was extreme. The sight of the pins sticking through his body was terrifying and I’ll never forget his screams.
Learning how to do pin care
My son was screaming and crying while everyone attempted to comfort him while the PT showed us his Pin Care. He was horrified to see the fixator and now someon was toughing it. It was not a good time to learn how to care for his fixator.
The PT showed us supplies includeding sterile saline, sterile gauze pads, long sterile q-tips, gloves, a pad to catch fluids underneath his leg and dressings called Mepilex AG (with silver) dressings, sterile scissors from a suture kit and alcohol pads to wipe the scissors each time I needed to cut a new dressing to size. I paid as much attention as I could while my child screamed and cried. The next day we were shown again and the day after that he was discharged from the hospital.
I was given a bag with some supplies and arrived home after a stressful 3-hour drive…hoping I would remember. As an Occupational Therapist I felt fairly prepared but when it’s your own child…things are different. I was told to shower him first to remove the drainage and then to complete pin care and we quickly realized that we needed a shower chair and bench.
The pins drain…a lot
During the hospital stay, the pins drained a lot. Drained yellowish to clear bloody fluid that they told us would lessen over time. It did, but for the first two weeks or so I changed 5-6 washable chuck pads under him daily. When he stood up, the fluid ran down his leg which is one of the reasons the dressing was so important. What was stuck to the dressing dried and needed to be washed off with some sterile saline before I could remove the dressing at times.
The drainage lessened greatly after about 2 weeks and nearly stopped after we stopped turning the fixator to lengthen the bone.
Running out of supplies
A few days after returning home I ran out of supplies. “I’ll pick them up at the local hospital supply store.” I thought. I was very wrong. I called every store within 2 hours of our home and couldn’t find the q-tips or gauze pads let alone the silver dressings. To increase my anxiety, the pin that caused the most trouble in the hospital began to develop a thick yellow goop and my son’s fever went up to 100. It’s an infection.
We are nearly 3 hours from my son’s specialist and popping him into the car and driving for a checkup was not an option.
I called and the surgeon had me text photos to him and called in an antibiotic immediately. My son started on cephalexin 300mg 3x a day for 10 days. The hospital overnighted us some supplies and I spoke to their wound care nurse on the phone. Why didn’t I see the wound nurse in the first place? He replaced the sterile saline with something called vashe which has been amazing. Way better than the saline and I’ve used it since!
External Fixator Pin Care Supplies Given at Discharge
- Sterile saline
- Sterile 4×4 gauze pads
- Sterile long q-tips
- Stockingnette 4″
- Mepilex AG (only gave us 2)
- Chuck pads for under leg to catch drainage
- Sterile scissors + alcohol wipes for cleaning
External Fixator Pin Care Supplies I Actually Use
- Vashe wound care wash
- Sterile 2×2 gauze pads
- Stickingnette 4″
- Washable chuck pads
- Dial antibacterial soap for shower
- Sterile specimin cup
- Mepilex AG (silver) daily – I ordered more and request extras at our appointments
- They do make a plain Meiplex that is not the right one, the silver one kills germs.
- Sterile scissors + alcohol wipes for cleaning
Steps for External Fixator Pin Care
- Shower washing around pins but not touching wounds.
- Longer shower if there is more drainage to remove
- Pat leg dry but don’t touch fixator, towel can have germs
- Put on gloves and place 6 2×2 sterile gauze pads into a sterile specimen cup so they can be wet with vashe (I use the same cup over and over)
- Why 6? One gauze pad for each pin + an extra to clean fixator.
- Soak gauze pads with Vashe so they’re wet but not dripping
- Wrap each pin with 1 gauze pad soaked in Vashe
- Each pin gets it’s own gauze pads.
- Don’t touch other pins with gauze from different pin, this can spread infection.
- Wait 3-4 minutes for Vashe to work
- Remove gauze pads flossing around and between pins to remove drainage.
- Do not push anything into the opening, only wipe away from the wound
- If I have to I use a q-tip and roll away from the opening to remove pieces of skin or drainage. My son hates this so I try to avoid it and if we rinse well in the shower it helps a lot.
- If drainage is still on a pin, re-wrap pin and repeat.
- This is rare, most comes off in the shower.
- Wipe fixator itself with spare gauze pad to kill germs and clean
- Air dry
- Change gloves
- Get scissors and wipe with alcohol wipe
- Open Dressing & cut slots to fit over pins
- When skin is no longer wet apply dressing
- Cut generous stockingnette and place over fixator
- This is not necessary per the MD but I feel as though it keeps things from touching the fixator and also helps my son emotionally because he doesn’t have to look at it.
- Dress in snap pants and go about day checking pins here and there.
Things we can’t live without
The Vashe has been so important, I’m not sure why we didn’t get any during our teaching session at the hospital but his pins started looking better right after we used it for the first time. I also wish my son was placed on a precautionary antibiotic before we left the hospital because he had a pin that drained a lot there and had an infection around the 3rd day we arrived home. I feel as though it could have been prevented.
Addidas snap pants! These have been amazing and I can’t imagine trying to dress his leg without them. He’s in a lot of pain and while months later he was able to pull over large size regular pants…that was not an option in the beginning. I searched and searched for these and eventually found them on Amazon.
In preparation for this we got an adjustable bed frame and a non-toxic mattress.
While the surgeon told us we didn’t need the vashe and the meiplex AG daily I noticed that the pins started to get more drainage and crusty without it. I told him this and he said it was okay to use if we felt it was necessary. After we stopped turning the fixator 4x/day I was able to use it ever few days but to me, it was a must during the active portion of having this fixator and lengthing the bone.
The best price we found on the Mepilex AG dressings were from this shop of medical supplies. We did get some from the hospital but not enough and they were so important with keeping away pin infections.
The shower is so important. This wasn’t emphasized enough by the hospital. It washes off most of the drainage and makes pin care time much shorter and less work. Pin care has been so stressful for our 6-year-old that any time we can save from cleaning the pins is a huge help. The shower bar has been really important and also the one we installed for the toilet. It helps him stand up and prevent falling.
The hospital gave us 4×4 gauze pads and these were way to big to fit between the pins. The 2x2s work much better for the spacing on my son’s leg.
As the drainage slowed the Mepilex hasn’t been needed as often and a sign that the drainage was seriously reducing was the fact that the Mepilex was no longer sticking. The surgeon’s assistant told us that we could place cleaned binder clips, from office supply, on the pins to keep the dressing from sliding away as long as they didn’t touch the skin.
(Pinterest image below)
While this post in no way makes an attempt to diagnose or treat any medical conditions. I hope it gives some insight into what we have experienced and what someone else may be going through. I decided to put this out there because I had such a hard time finding anyone who could relate to what we are going through and wanted to help others know that they’re not alone! If you have anything to share please comment below. Maybe your words will help someone else.