Abstract
IntroductionExternal fixation is associated with the risk of pin loosening and pin infection potentially associated to thermal bone necrosis during pin insertion.ObjectiveThis study aims to investigate if the use of external fixator systems with unicortical pins reduces the heat production during pin insertion compared to fixators with bicortical pins.MethodsPorcine bone specimens were employed to determine bone temperatures during insertion of fixator pins. Two thermographic cameras were used for a simultaneous temperature measurement on the bone surface (top view) and a bone cross-section (front view). Self-drilling unicortical and bicortical pins were inserted at different rotational speeds: (30–600) rpm. Maximum and mean temperatures of the emerging bone debris, bone surface and bone cross-section were analyzed.ResultsMaximum temperatures of up to 77 ± 26 °C were measured during pin insertion in the emerging debris and up to 42 ± 2 °C on the bone surface. Temperatures of the emerging debris increased with increasing rotational speeds. Bicortical pin insertion generated significantly higher temperatures at low insertion speed (30 rpm)ConclusionThe insertion of external fixator pins can generate a considerable amount of heat around the pins, primarily emerging from bone debris and at higher insertion speeds. Our findings suggest that unicortical, self-drilling fixator pins have a decreased risk for thermal damage, both to the surrounding tissue and to the bone itself.
Highlights
External fixation is associated with the risk of pin loosening and pin infection potentially associated to thermal bone necrosis during pin insertion
This study aims to investigate if the use of fixator systems with unicortical pins reduces the heat production during pin insertion compared to fixators with bicortical pins
The temperature increase within the bone was always more pronounced for bicortical pin insertion compared to unicortical pin insertion (Fig. 8)
Summary
External fixation is associated with the risk of pin loosening and pin infection potentially associated to thermal bone necrosis during pin insertion. Self-drilling unicortical and bicortical pins were inserted at different rotational speeds: (30–600) rpm. Results Maximum temperatures of up to 77 ± 26 °C were measured during pin insertion in the emerging debris and up to 42 ± 2 °C on the bone surface. Our findings suggest that unicortical, self-drilling fixator pins have a decreased risk for thermal damage, both to the surrounding tissue and to the bone itself. For self-drilling pins at high rotational speeds the temperatures occurring on the bone surface can reach levels that are detrimental to biological tissue. As unicortical pins need not to be drilled through the entire cortex the heat production during insertion is likely to be reduced compared to bicortical pins penetrating both cortices
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