Abstract
Aim : Common complications of external fixators include pin-loosening, infection and loss of reduction/malunion. These are increased with prolonged fixation. The main aim of this systematic review was to investigate HA-coated versus uncoated external fixator and determine benefits in terms of pin loosening, infection and loss of reduction/malunion. Material and Methods : A systematic literature search using PubMed, EMBASE, OVID SP, Cochrane database, ClinicalTrials.gov website and the references of the studies identified was undertaken on 26th August 2014. Comparative trials investigating HA-coated versus uncoated external fixation pins were identified. These were limited using strict eligibility criteria and critically appraised as per the CASP and CONSORT guidelines. Primary outcome measures included pin loosening and infection. Secondary outcome measures included loss of reduction/malunion. Results : Seven studies were identified of which five studies demonstrated a statistically significant reduction in loosening with HA-coated pins. There was insufficient evidence to demonstrate any clinical benefits, such as numbers needed to treat to avoid early removal of pins. Review of the studies included also demonstrated insufficient evidence to determine any significant clinical benefit with regards to infection and malunion. Critical appraisal demonstrated average methodological quality of the studies. Conclusion : HA-coating of external fixator pins improves bone fixation and reduces loosening in patients undergoing prolonged fixation procedures, such as leg-lengthening, but the influence on infection and malunion is not clear. Further large, well-designed randomised controlled trials with observer blinding, standardized pin insertion and pin care investigating clinically relevant pin loosening, infection and malunion are recommended. Patient reported, functional outcome measures should also be considered.
Highlights
The external fixator has been used for more than a century[1]
The abstracts were thoroughly screened and 7 studies comparing hydroxyapatite coated with uncoated external fixation pins were identified
The main purpose of this systematic review was to determine whether HA-coating of external fixation pins has a beneficial effect on rates of loosening and pin-track infections compared to uncoated pins
Summary
The external fixator has been used for more than a century[1]. Despite many advances in the development of external fixation techniques, pin- tract infection and loosening are still significant complications. They are the most commonly occurring complications during limb lengthening using external fixation, with some studies reporting an. Indications for external fixators include damage control orthopaedics[5] and definitive treatment frames used in managing acute fractures, bone loss/deformity and limb lengthening. Ilizarov began to develop the basics concepts of definitive external fixator treatment in 1951 after seeing many WWII veterans with tibial fractures. External fixation techniques have developed considerably and are essential components in the treatment of congenital and post-traumatic short limbs. Clinical success or failure of limb lengthening is gauged by the amount of length produced, quality of bone generated and avoidance of complications during and after the lengthening process[6]
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