Biomechanical evaluation of two halo pin designs, with, and without, intact periosteum

Abstract

The presence of periosteum has been hypothesized to adversely affect halo pin penetration and performance (Voor, 1992. Ph.D. Dissertation, Tulane University, New Orleans, LA). However, biomechanical testing of halo pins has historically been conducted on bone specimens with periosteum removed. This may have lead to an unrealistic measure of biomechanical pin performance. Our study compares the biomechanical performance of two halo pin designs on bovine bone specimens with, and without, intact periosteum. The two pin designs included in this study were the conventional pin (Bremer Medical) with conical tip, and a newly released trochar-style pin (DePuy AcroMed). Results showed the mean peak load before failure of the trochar-style pin (mean ±95% confidence interval: 656±29 N) to be significantly higher than the conventional pin (517±53 N) on bone with intact periosteum ( p=0.001). With the periosteum removed, the mean peak load of the trochar-style pin (655±99 N) remained statistically the same ( p=0.987), while the mean peak load of the conventional pin (634±65 N) increased significantly ( p=0.026). Variation of the data of the conventional pin significantly decreased from 32 to 19% on removal of periosteum ( σ=165–103 N, respectively, p=0.0967), while variation of the trochar-style remained statistically the same at 30–29% ( σ=193–188 N, respectively, p=0.954). These results show that the trochar-style pin may be biomechanically superior to the conventional pin for vertical forces experienced during immobilization. The performance of this new pin style may also not be significantly affected by overlying soft tissue. Use of this new pin style may, therefore, improve overall stability and fixation of the halo apparatus.