Patient-reported symptoms of ‘calm’, ‘irritated’ and ‘infected’ skeletal external fixator pin site wound states:a cross-sectional study

Objective: To explore the frequency, severity and variances in patient-reported symptoms of calm, irritated and infected skeletal pin sites. Methods: A cross-sectional within-subjects repeated-measures study was conducted, employing a self-report questionnaire. Patients (n=165) treated with lower limb external fixators at 7 English hospitals completed a designed questionnaire. Three sets of retrospective repeated-measures data were collected relating to calm, irritated and infected pin sites. Results: Significant differences were revealed between each of the three pin site states (calm, irritated & infected) in the degree of redness, swelling, itchiness, pain, wound discharge, heat/burning, shiny skin and odour. In relation to difficulty or pain using the affected arm or leg, difficulty weight bearing on the leg, nausea and/or vomiting, feeling unwell or feverish, shivering, tiredness/lethargy and disturbed sleep, significant differences were demonstrated between infected and irritated states and infected and calm states, but not between irritated and calm Conclusions: The findings provide greater depth of understanding of the symptoms of pin site infection and irritation. Patients may be able to differentiate between different pin site states by comparing the magnitude of the inflammatory symptoms and the presence of other specific symptoms that relate solely to 2 infection and no other clinical state. The irritated state is probably caused by a different pathological process rather than infection and may be an indication of contact dermatitis.