External Fixation Pins Research Articles

Reconstruction after hemimandibulectomy using a costochondral rib graft and a dacron-urethane tray with autogenous iliac bone: Report of a case

A case is presented that describes a method of mandibular reconstruction using a costochondral graft for replacement of the condyle that is attached to a dacron-urethane tray filled with particulate bone and marrow harvested from the ilium and secured to the distal mandibular segment with stainless steel wire. The requirements of graft immobilization and early return to function were met by initially using maxillomandibular fixation and then using external pin fixation with a small hinge incorporated into the acrylic bar. The advantages of using a dacron-urethane tray as opposed to a metallic tray are described, and the use of costochondral grafts is reviewed.

The role of external fixation in the treatment of posttraumatic osteomyelitis.

External skeletal fixation played a central role in the reconstruction of 30 limbs involved in posttraumatic osteomyelitis. The tibia was involved in 15, the femur in six, the ankle in five, and the foot and radius in two each. Of the thirty limbs, 27 were ununited. Positive bacteriology and/or histology was found in each case. A total of 36 frames were used with 20 unilateral half-frame constructs and 16 bilateral transfixion frames. The average duration of external fixation was 60 days. Specific procedures for soft tissue coverage were required in 21 cases and autogenous bone grafting in 26. Loosening and local infection occurred in three of 168 external fixation pins. There were no cases of pin-track osteomyelitis, fractures through pintracks, or neurovascular damage from pin insertion. Infection was controlled in 29 of 30 limbs, with one requiring a below-knee amputation. Skeletal union was achieved in all cases. At an average follow-up of 35 months, 20 of 28 lower limbs in 27 patients tolerated full weight bearing without ambulatory aides. Four used a patellar tendon-bearing polypropylene orthosis, two used a cane, and one a walker. In the 23 patients ambulating without upper-extremity aides, the average time from the start of treatment to reach this functional status was 14 months.

External fixation pin: an in vitro general investigation.

Surgical drilling and pin insertion can lead to mechanical and thermic damage of the bone. A methodology giving reproducible in vitro records of insertion and holding parameters of threaded implants is presented. Both drilling and tapping are related to the cutting technology. To understand the basic principles of the cutting technology some important parameters of drilling and tapping of an external fixation pin are defined. A bone model was selected based on specific mechanical and thermal properties of the bone tissue. In addition, a specific instrumentation was designed in order to compare the insertion characteristics and the anchorage of different pins. Electronic scanning microscopy of the samples was systematically performed to evaluate the quality of the bone thread. The in vitro measurements of the shearing torque and the pull-out force are representative of the immediate holding power of a pin. The different holding parameters were then correlated. Temperature measurements were performed during drilling, smooth part penetration (transfixing pins), tapping, and screwing. The final objective of the study was to develop new threaded implants with better biomechanical characteristics.

Proximal Tibial Transfixion for Skeletal Traction

Pin placement in the proximal tibia is commonly performed by passing the pins percutaneously, without visualization of the underlying neurovascular and anatomic structures. Neurovascular injuries are uncommon. Complications are avoidable through a thorough familiarity with the location of the neurovascular structures. Six cadaveric legs were dissected and the three-dimensional anatomy of the peroneal nerve in the proximal one-third of the leg defined, with the use of profile radiography. The nerve is situated predominantly posterior to the tibia. The pin should be passed through the middle of the tibia (in cross section) strictly in the coronal plane to avoid neural damage. Skeletal traction or external fixation pins may, therefore, safely be placed in the proximal tibia.

Electrostimulation and Bone Grafting of Nonunions with Bone Defects

Fifteen patients with post-traumatic nonunions and a bone gap, eight of which were infected, were treated with bone grafting and electrostimulation using a stimulator connected to the external fixation pins. All nonunions healed with a median time of 9 months, and no recurrences of the osteomyelitis were observed.

Modification of the biphase appliance for large mandibular resections.

Since the Joe Hall Morris external pin fixation device was first introduced, it has been used with much success in the treatment of mandibular trauma and the reconstruction of mandibular defects. Because it is well tolerated and provides such predictable stability, the device has been modified by several authors in very creative ways to manage unique clinical problems.lV3 One of the few difficulties in its use can arise when attempting to perform large resections involving bone removal to the angle of the mandible bilaterally. We have found the monophase connecting rod apparatus to be, at times, cumbersome and difficult to position in this circumstance. Firm stability of the ramus segments is not always assured, and placing the connecting rods away from the surgical site can be difficult. In

下がく頭を含む下がく骨切除時の下がく骨偏位防止法の１工夫 外装型がく誘導装置について

The method to align and stabilize the remaining mandibular segment for the mandibulectomized patient including the mandibular condyle was reported in this article. The method used is modification of the external pin fixation. The difference between the ordinary method and the author's method is that the devices guiding the mandibular movement are attached to the ordinary external pin fixation appliance.The merits are as follows.1. The patient can open his mouth guided by the devices attached to the ordinary external pin fixation appliance without changing the position of the remaining mandibular segment.2. The patient can eat orally in the early postoperative period.3. Postoperative care becomes easier because observation of the oral cavity is easy.

Measurement of the maximum torque at the time of retrieval of external fixation pins (MTR)

Measurement of the maximum torque at the time of retrieval of external fixation pins (MTR)

既製がく骨骨折用創外固定装置を利用したがく・顔面骨固定について

This paper presented the new device of external pin fixation method and appraisal of its clinical use. This new apparatus consisted of three parts of two different types of pin system, namely, HH (the initial of Hajime Hayashi) type pin system, HY (the initial of Hiroyuki Yamanaka) type pin system and the kirschner wire (diameter 3.0 mm). This combined fixation system was developed based on rigidity of pin, flexibility of klemme and easy adaptation of length of wire rod.It was applied to six cases of iliac bone grafting and five cases of maxillo-facial bone fracture, to which it may have been thought that ordinary fixation were not enough to get the stability of grafted or fractured bone. This worked very well in all cases, except in one case of iliac bone grafting because of its poor bed condition.Thus, clinical results showed this new type of external fixation system (we call it “Mei-dai system”) was much more useful and easier to get rigid fixation than other pin systems (ex. HH type alone, HY type alone, Roger-Anderson type etc.).

Tissue oxygen tension in externally stabilized tibial fractures in rabbits during normal healing and infection.

Permanently implanted Silastic tonometers were used to measure average extracellular oxygen tension in the medullary cavity of osteotomized rabbit tibias stabilized with external pin fixation. During uncomplicated healing the baseline bone pO2 rose slowly with time from 10 to 20 mm Hg while during staphylococcal infection pO2 varied between 8 and 15 mm Hg and showed no correlation with the healing time. The maximal response of the bone pO2 to oxygen breathing correlated linearly with the healing time whether the osteotomy was infected or not. On the 42nd day the maximal pO2 during systemic hyperoxia was 85 mm Hg for the control bones, 42 mm Hg for the osteotomized bones, and 30 mm Hg for the infected osteotomized bones. The results indicate moderate bone tissue hypoxia during uncomplicated healing and more profound hypoxia during healing affected by infection.

Standardized Method to Measure the Fixation Quality of a Pin: Theoretical Derivation and Preliminary Results

A vibration method to measure the quality of anchorage of an external fixation pin is proposed. Attention is paid to the interpretation and standardization of the measurements to obtain reliable results. The preliminary results of a series of in viva measurements on tibial and radial pins are presented. The progress with time and correlation with the maximum torque moment at the time of retrieval are shown.

Fatigue performance of external fixator pins.

The fatigue performance of several types of commonly used external fixator pins was examined. The pins were tested under a cyclic bending mode. A strength reduction factor (SRF) was defined to quantify the effect of stress concentration caused by the pin threads as compared with the smooth portion of the pin. The half pins tested had much higher SRF values than the corresponding full pins because of the smaller root diameter of the threaded regions. The use of finer threads and a cold rolling process appeared to increase the pin fatigue strength. In some pins, the depth markers on the smooth portion and the self-tapping fluted region were sites of significant stress concentration. When certain half pins are severely loaded under clinical conditions, they may fracture because of fatigue.

Combining the irby head frame and the Morris external pin fixation set to stabilize midface fractures

Combining the irby head frame and the Morris external pin fixation set to stabilize midface fractures

The management of open tibial fractures with associated soft-tissue loss: external pin fixation with early flap coverage.

Meaningful data on the management of open tibial fractures cannot be obtained unless one categorizes the injury according to fracture type, degree of soft-tissue loss, and the velocity of the injury. Treatment by converting the type III injury to a type II injury with well-vascularized soft tissue is presented. Eighteen patients with 20 type III and type IIIa wounds were treated in a prospective fashion employing a combined orthopedic and plastic surgical scheme based on the tenets of early radical debridement, a "second look" operation, muscle or muscle-skin flap cover within 5 days of injury, external pin fixation, and ambulation within the first 3 weeks of injury. All fractures united in a mean time of 4.0 months. The mean hospitalization was 4.2 weeks. There have been no chronic infection, osteomyelitis, nonunion, shortening, or tissue breakdown.

Open fractures of the tibia

One hundred and two consecutive open fractures of the tibial shaft were treated from 1970 to 1976. Four required primary amputation. The remainder received standardized wound care, consisting of surgical débridement and delayed primary wound closure. Soft-tissue injuries were classified according to severity, because the initial injury was the most important prognostic factor. All patients received a seventy-two-hour course of parenteral antibiotics. Fifty-six fractures were managed with cast immobilization, thirty-five with rigid internal fixation, and seven with rigid external pin fixation. The over-all rates of infection (15 per cent) and delayed union (13 per cent) are not directly comparable to other series because one must consider the severity of each injury when analyzing results. Management of the fracture itself should be individualized. The risk of primary wound closure does not appear to be warranted.

Neurovascular Complications Following Tibial Osteotomy in Children

Anterior tibial sensory and motor losses following tibial osteotomy in children may result from any of 3 distinguishable etiologies. Peroneal nerve traction does not result in abnormalities of the dorsalis pedis pulse, pain on passive muscle stretch or a tense anterior tibial compartment. An anterior compartmental syndrome may or may not produce an abnormal pulse, but passive muscle stretch is painful and the compartment is tense and tender. Significant occusion of the anterior tibial artery produces diminution of the pulse and painful muscle stretch in the absence of a tense compartment. Certain pre-, intra- and postoperative measures can minimize the chance of these complications and facilitate their detection and treatment. These include: prophylactic fasciotomy, external pin fixation and frequent, thorough examination. If one of these complications arises, dressing should be loosened and the leg returned immediately to its preoperative position. Subsequent therapy is based on continued observation and the specific diagnosis.

External Pin Fixation with Early Flap Coverage for Open Tibial Fractures with Soft Tissue Loss

Meaningful data on the management of open tibial fractures cannot be obtained unless one categorizes the injury according to fracture type, degree of soft tissue loss and the velocity of the injury. Treatment by converting the type III injury to a type II injury with well vascularized soft tissue is presented. Eighteen patient with 20 type III and type III(a) wounds were treated in a prospective fashion employing a combined orthopedic and plastic surgical scheme based on the tenets of early radical debridement, a "second look" operation, muscle or fasciocataneus flap cover within the first 3 weeks for injury. All fractures united in a mean time of 6.0 months. The mean hospitalization was 6.2 weeks. There have been chronic infection, osteomyelitis nonunion, shortening or tissue breakdown. Keyword: Open tibial fractures, external pin fixation DOI:10.3329/jom.v11i1.4265 J Medicine 2010: 11: 28-32

The Late Sir Harold Gillies

To the Editor:— InThe Journalfor Dec. 3, 1960, p. 1881, your correspondent in the United Kingdom mentions the recent deaths of 2 noted British surgeons, Sir Gordon Gordon Taylor and Sir Harold Gillies. The letter gives the impression that Gillies was the originator of the external skeletal fixation apparatus for the treatment of jaw fractures. In his book, however, he states that this was brought to his attention late in 1940 by F. W. Waknitz, an American member of the orthopedic unit and was a Roger Anderson apparatus intended for phalangeal fractures adapted for the purpose. Gillies made so many more significant contributions to plastic surgery, that it seems strange that this relatively minor item of technique should be singled out for special mention by your correspondent. The basic principle of external pin fixation of fractures is believed to have been formulated originally by Parkhill, who in 1897

Treatment of jaw fractures.

FRACTURES of the mandible, the maxilla, and the zygomaticomalar compound are treated by a variety of surgical specialists, depending upon the hospital to which they are admitted and the special skills and interests of the surgeons in the community. Thus, dental surgeons, otolaryngologists, plastic surgeons, orthopedic surgeons, and general surgeons may have special interest in the management of facial fractures, depending upon the region in which they practice. Often two of the above-mentioned specialists will collaborate in the diagnosis and treatment of this type of trauma. A great variety of techniques and apparatus have been advocated for the treatment of jaw fractures. Some of the apparatus recommended at one time or another includes external pin fixation devices, plaster head caps with wire suspension or traction, Kirschner wire fixation, and complex or expensive dental splints. There has been much discussion in recent years concerning the indications for open reduction in certain

ARTERIOVENOUS ANEURYSM RESULTING FROM APPLICATION OF ROGER ANDERSON SPLINT

While it is admitted readily that the use of external pin fixation has a definite place in the management of fractures of the mandible, certain potential complications in its technical application may be overlooked. A patient recently under our care demonstrates a complication that we feel should be recorded. A man suffered an oblique fracture through the right angle of his mandible. An early reduction was performed and the teeth were wired in occlusion. Because the mandible was edentulous posteriorly a Roger Anderson external pin fixation splint was substituted to stabilize the posterior fragment in the reduced position. The wires were removed after partial union to permit early motion and use. At the time of application of the splint, one of the pins accidentally injured the underlying facial artery and vein. An immediate swelling developed that pulsated. The mass grew quickly to the size of a walnut. Pulsation continued for