Femoral Pin Research Articles

Subtrochanteric Fracture as a Complication of Proximal Femoral Pinning

The circumstances of subtrochanteric fractures following the use of multiple pins for fixation of femoral neck fractures were reviewed in four women (age range, 67-94 years). Internal fixation by use of multiple pins in the proximal femur is a common orthopedic procedure. The pins, however, create a significant stress riser in the lateral subtrochanteric cortex. Subtrochanteric fracture has been reported after internal fixation of slipped capital femoral epiphysis with multiple conventional pins and, recently, after internal fixation of femoral neck fractures with large Garden screws.

Pelvic Disruption

Using the previously outlined classification of pelvic disruption to assess the displacement and stability, a logical method of treatment for the individual case follows. Anteroposterior fractures of the open-book variety and with intact posterior sacroiliac ligaments require simply reduction of the fracture (closure of the book), and immobilization by a sling, plaster spica or external skeletal fixators. The lateral compression types all produce some degree of inward rotation of the hemipelvis. If the supine position does not reduce the hemipelvis spontaneously, a general anesthetic and the application of external rotation forces are often required. Immobilization can be maintained either by complete bed rest with traction through a supracondylar femoral pin or with external skeletal fixators. Pelvic slings or binders will increase the deformity and are contraindicated. The very unstable types of vertical shear fractures can be reduced easily with traction, but maintenance of reduction is difficult. Fracture healing may be delayed because of instability through the hemipelvis and some degree of compression through the posterior fracture is desirable, either by various forms of external skeletal fixation, or occasionally by open reduction. Pelvic fractures associated with acetabular disruption and requiring open reduction of the acetabular fracture also require anatomic repositioning of the pelvic fragments simultaneously, in order to anatomically restore the integrity of the acetabulum. Finally, the pelvic fracture should not be neglected during the early phase of general resuscitation of the patient, but management should proceed concomitantly with the management of the associated injuries. Delay in treatment of the pelvic injury makes management much more difficult and even hazardous at a later phase.

The Hazards of Tibial Pin Replacement in 90???90 Skeletal Traction

Tibial pin placement and 90--90 traction may lead to serious knee difficulties. Not only proximal tibial epiphyseal insult, but also serious displacement of the tibia on the femur may occur. In light of these potential complications, distal femoral pin placement should always be preferable for 90--90 traction in treatment of fractured femurs in children.

Preoperative skeletal traction in scoliosis

To determine the role of preoperative traction in the treatment of spinal curves, ten patients with curves averaging 81 degrees by the Cobb measurement were studied. Each patient was treated in traction by means of a halo or skull tongs and femoral pins for two to three weeks prior to the surgical correction of the scoliosis with instrumentation. Weights were added to the traction apparatus, 1.8 kilograms a day, to a maximum of 18.1 kilograms. Pretraction supine roentgenograms were compared with supine roentgenograms made at three-day intervals throughout the traction period. Preoperative traction resulted in an average improvement of the curves of 34 degrees, or 41 per cent of the initial curve. Most of the correction was obtained within the first week of traction. Further correction during surgery with Harrington instrumentation yielded 13.5 degrees on the average (16 per cent) so that combined correction averaged 47 degrees, or 57 per cent.