Pin Fixation Research Articles

Implant removal rate after partial carpal arthrodesis in dogs: A retrospective analysis of 22 cases.

The purpose of this study is to determine the rate of implant removal after partial carpal arthrodesis and to investigate factors associated with implant removal. Case records of 22 dogs that underwent partial carpal arthrodesis at two private veterinary referral hospitals were reviewed. Details retrieved were body weight at time of surgery, sex, neuter status, breed, age, cause of carpal hyperextension injury, joint(s) involved in carpal hyperextension injury, laterality, type of implant, administration of post-operative antibiotics, post-operative outcome and indication for implant removal. Association between these factors and implant removal was evaluated. Of 22 partial carpal arthrodesis, 12 (55%) had implant removal due to persistent lameness and 9/12 (75%) returned to full and acceptable function after implant removal. Indications for implant removal were implant interference (8), infection (4), and migration (1). When comparing type of implant, there was a significant difference when observing implant removal rates (p = 0.04). All 5 dogs with pins and wires (100%) required implant removal. Of 17 dogs with a plate, 7 (41.2%) required implant removal. Implant removal was performed on average 114 days post-operative. Implant removal after partial carpal arthrodesis was frequent and was commonly indicated due to pin and wire fixation or plate implant interference. This study may impact how we prepare clients for potential post-operative complications and implant removal when recommending partial carpal arthrodesis.

Dexmedetomidine as an adjuvant to scalp block in patients undergoing elective craniotomy: A prospective randomized controlled trial.

Regional techniques minimize anesthetic requirements and their effects may be beneficial. There is a lack of consensus and evidence concerning alternative analgesia strategies for cranial neurosurgery. This study was designed to evaluate the effect of scalp block with or without dexmedetomidine combined with general anesthesia on hemodynamic stability, opioid consumption and postoperative pain in patients undergoing elective craniotomy. One hundred five patients undergoing elective craniotomy for tumor dissection were randomly divided into three groups to receive scalp block as an adjuvant to general anesthesia: with either 40ml ropivacaine 0.5% (Group R), 40ml ropivacaine 0.5% plus dexmedetomidine 1μg/kg (Group RD) or 40ml saline as a placebo (Group C). After a standard induction sequence using propofol, fentanyl and a single dose of rocuronium, patients were intubated. Bilateral scalp block was given immediately after induction. Anesthesia was maintained with propofol and remifentanil infusion. Five minutes before head pinning scalp block was performed by blocking the supraorbital, supratrochlear, auriculotemporal, occipital, and postauricular branches of the greater auricular nerves. All patients were monitored with electrocardiogram, invasive blood pressure, pulse oximetry and BIS monitoring. Primary outcomes measures were overall hemodynamic variables during surgery and intravenous fentanyl and remifentanil consumption. Mean arterial pressure (MAP) and heart rate (HR) were recorded at seven time-points: scalp block (T1-baseline), pin fixation (T2), skin incision (T3), drilling (T4), dura matter incision (T5), dura matter closure (T6) and skin closure (T7). For all time points it was recorded the mean value after 3 consecutive measures with 5min interval. Secondary outcome was postoperative pain intensity using visual analog scale 24 and 48h after surgery. VAS scores, fentanyl and remifentanil were evaluated using Kruskal-Wallis test. MAP and HR were compared by One-Way repeated measures Anova (GLMM) using time as random efect and by One-Way Anova using time as fxed efect. Mean arterial pressure was significant lower at skin closure compared to baseline in group R (p<0,001) and in group RD (p<0,001). Patients in group RD showed significant lower heart rate at dura matter incision, dura matter closure and skin closure compared to baseline, pin fixation and skin incision time points (p<0,001) and reported significantly less heart rate than group C (p<0,001) and group R (p<0,001) during dura matter incision, dura matter closure and skin closure time points. Patients in group RD receive significant lower fentanyl than group R (p<0,01). The intraoperative consumption of remifentanil was significant higher in control group compared to group R (p<0,01) and to group RD (p<0,001). Additionally, remifentanil consumption was significant lower in group RD as compared to group R (p<0,001). Postoperative pain had no statistically differences between the three groups at 24h and 48h after craniotomy (Preop VAS: p=0,915, VAS 24: p=0,284, VAS 48, p=0,385). No adverse effects were noted. Our study indicated that addition of dexmedetomidine to scalp block with ropivacaine 0.5% provided significantly better perioperative hemodynamic stability during elective craniotomy. Moreover, scalp block with or without dexmedetomidine reduced fentanyl and remifentanil consumption, but it didn't significantly prolonged analgesia in patients undergoing elective craniotomy.

Outcomes of young active patients with displaced clavicle fractures treated with Rockwood pin.

Various fixation techniques have been described for midshaft clavicle fractures in the literature. We hypothesized that use of the Rockwood pin for fixation of displaced midshaft clavicle fractures would result in favorable outcomes in a young active cohort. Patients aged 10-35years who underwent Rockwood clavicle pin fixation at a single institution were identified. Preoperative and postoperative radiographs were reviewed and assessed for fracture characteristics, postoperative alignment, and radiographic union. Postoperative outcome scores were obtained. A total of 39 patients (age 17.3 ± 3.9years) with clavicle fracture treated with Rockwood pin were identified. Radiographic review demonstrated that 88% of fractures were 100%, or more, displaced, and surgery achieved near-anatomic reduction in 92% of cases. Average time to radiographic union was 2.3 ± 0.8months, and average time to clinical union was 2.5 ± 0.3months. One patient required revision for nonunion (3%). Complete outcome responses were obtained for 24 patients, with an average 40 ± 27.7months of follow-up. Mean Total Clavicle Functional score was 2.75 ± 3.6 for minor patients. For adult patients, Nottingham Clavicle score was 90.7 ± 10.7, mean American Shoulder and Elbow Society score was 92.4 ± 11.2, and mean Single Assessment Numerical Evaluation score was 88.8 ± 21.5. 77% of adults reported no long-term functional limitation; 54% reported a bump at the prior fracture site, but 100% reported satisfaction with shoulder appearance. In our cohort of young active patients, treatment with Rockwood pin allowed for anatomic reduction, healing with a low nonunion rate, and favorable patient reported outcomes.

Different methods of hydroxyapatite‐based coatings on external fixator pin with high adhesion approach

AbstractIn this review paper, different methods of hydroxyapatite‐based coatings on external fixation pins with improvement in the adhesion strength are explained. Different coating methods such as dip coating, surface‐induced mineralization, plasma spraying, physical vapor deposition magnetron sputtering, micro‐arc oxidation, electrophoretic deposition, chemical vapor deposition, ion beam assisted deposition, sol‐gel dip coating, pulsed laser deposition, and electrohydrodynamic coating are investigated. The micro‐arc oxidation method showed high degradation delaying of the substrate with a high‐voltage electrolyte solution. Moreover, controlling the coating porosity by applying the gas is a good feature of the physical vapor deposition magnetron sputtering method. The comparison of the hydroxyapatite (HA) coatings method showed that the plasma spraying method leads to better coating features between the coating methods on the implant pins.

Transphyseal distal humeral separation in neonates: A case series

IntroductionBirth trauma is a rare condition. Typically, injury in neonates occurs as a result of obstetrical manipulation to allow delivery or from trauma sustained during a difficult passage through the birth canal. Transphyseal separation of the humerus is particularly rare. Diagnosis is not always straightforward and is prone to mistakes. There is a general consensus that the outcome is usually favorable. It is generally agreed that the fracture needs to be realigned, while the suggested methods in contention vary from a simple plaster cast to closed and even open reduction and percutaneous Kirschner wire fixation. The purpose of this study was to review our experience in treating transphyseal distal humeral separation in neonates to better define the diagnostic and therapeutic pathway. MethodsTen consecutive cases of transphyseal distal humeral separation in neonates were treated at our institution between September 2008 and June 2021. All cases were reviewed and clinical data collected on birth injury risk factors, diagnostic workup, age at diagnosis and treatment, and type of treatment. Results of treatment and outcome were analyzed for time to fracture union, complications and clinical alignment, range of motion and residual pain at the latest follow-up. ResultsMean age at diagnosis was 4.2 days (range 0 to 9 days) and time between diagnosis and treatment varied from three to 26 h (average 15 h). Risk factors for birth injury were present in six patients. Four patients were initially treated with closed reduction and cast immobilization, all the other cases were treated with closed reduction and percutaneous pinning. Arthrography was performed at the time of treatment in six cases. Average follow-up was 37 months (range 12 to 120 months). At the latest follow-up, all fractures had healed with full range of motion. No clinical or radiographic deformity requiring repeated surgery or physeal damage was observed. ConclusionsThis rare lesion may occur both in the presence and in the absence of risk factors. Due to the rarity of the injury, misdiagnosis and delayed diagnosis are not uncommon. Treatment with closed reduction and percutaneous pin fixation is advisable and safe.

Pin and Wire System Fixation for the Treatment of Comminuted Patella Fractures.

We describe the wiring technique and evaluate the radiographic and clinical outcomes of treatment with a pin and wire system (PWS) for comminuted patella fractures. From June 2013 to October 2018, 33 patients with comminuted patella fractures were treated using a PWS. Open reduction and internal fixation was performed with multiple pins and a wire. All patients were allowed full weight bearing without a brace. Radiographs were obtained to evaluate bone union, implant breakage, back-out of pins, and intra-articular gaps and step-off. Clinical outcomes and postoperative complications were assessed at final follow-up examination. All fractures were united. Thirteen cable wires in 13 patients were partially broken without displacement of fracture at an average of 7.4 months (range, 1-19 months) postoperatively. The average preoperative, postoperative, and final follow-up intra-articular gap and step-off were 11.7 mm, 0.5 mm, and 0.03 mm and 6.6 mm, 0.4 mm, and 0.2 mm, respectively. The average postoperative pin displacement was 0.1 mm (range, 0-0.8 mm). Deep infection was not observed after the surgery. The implant removal rate was 21% (7 of 33). Among these, the symptomatic implant removal rate was 9% (3 of 33). Additionally, 3 of 7 patients with implant removal had broken wires. The average flexion and extension of knee joints were 139.7° (range, 120°-150°) and -0.9° (range, -10° to 0°), respectively. A PWS prevents back-out of the pins and reduces intra-articular gaps and step-off distances to acceptable levels, even if the cable wire is partially broken. Therefore, a PWS is a good treatment option for comminuted patella fractures. [Orthopedics. 2023;46(5):291-296.].

Pinless Electromagnetic Neuronavigation During Awake Craniotomies: Technical Pearls, Pitfalls, and Nuances

Awake craniotomies are often performed with rigid pin fixation to support optical neuronavigation. Newer electromagnetic (EM) neuronavigation technology now enables unpinned cranial neurosurgery while maintaining robust intraoperative image guidance. Here, we share technical nuances, operative pearls, and lessons learned from our institutional experience using Curve EM neuronavigation during awake, unpinned craniotomies. We describe our process for patient positioning, instrumentation setup, system registration, intraoperative navigation, and surgical adjunct use (e.g., intraoperative neuromonitoring and intraoperative magnetic resonance imaging) in detail. At each step, we provide pearls for success and tips for pitfall avoidance based on our experience. Ten patients underwent awake pinless intra-axial tumor resection using Curve EM neuronavigation from May 2021 to August 2022 with a single surgeon. Postoperative transient neurological deficits were seen in 8 of 10 cases (80.0%), as all resections were taken to functional margins. Of the 9 patients with a 3-month follow-up visit at the time of publication, all 9 (100%) had improved or stable preoperative symptoms. No surgical complications, clinically appreciable inaccuracies, intraoperative losses of registration, unexpected postoperative magnetic resonance imaging findings, or errors related to the use of EM neuronavigation occurred. The technical pearls outlined here willhelp interested neurosurgeons integrate EM neuronavigation into awake craniotomies. In our experience, using unpinned neuronavigation during awake cases provides many advantages to the patient, surgeon, and entire operative team. It has thus become the standard practice at our institution.

Extra Lateral Pin or Less Radiation? A Comparison of Two Different Pin Configurations in the Treatment of Supracondylar Humerus Fracture.

Closed reduction and percutaneous fixation are the most commonly used methods in the surgical treatment of supracondylar humerus fractures. The pin configuration changes stability and is still controversial. The aim of this study was to investigate the relationship between surgical duration and radiation dose/duration for different pinning fixations. A total of 48 patients with Gartland type 2, 3, and 4 supracondylar fractures of the humerus were randomized into two groups-2 lateral and 1 medial (2L1M) pin fixation (n = 26) and 1 lateral 1 medial (1L1M) pin fixation (n = 22). A primary assessment was performed regarding surgical duration, radiation duration, and radiation dose. A secondary assessment included clinical outcome, passive range of motion, radiographic measurements, Flynn's criteria, and complications. There were 26 patients in the first group (2L1M) and 22 patients in the second group (1L1M). There was no statistical difference between the groups regarding age, sex, type of fracture, or Flynn's criteria. The overall mean surgical duration with 1L1M fixation (30.59 ± 8.72) was statistically lower (p = 0.001) when compared to the 2L1M Kirschner wire K-wire fixation (40.61 ± 8.25). The mean radiation duration was 0.76 ± 0.33 s in the 1L1M K-wire fixation and 1.68 ± 0.55 s in the 2L1M K-wire fixation. The mean radiation dose of the 2L1M K-wire fixation (2.45 ± 1.15 mGy) was higher than that of the 1L1M K-wire fixation (0.55 ± 0.43 mGy) (p = 0.000). The current study shows that although there is no difference between the clinical and radiological outcomes, radiation dose exposure is significantly lower for the 1L1M fixation method.

Use of Neuronavigation in Suturectomy for Craniosynostosis.

Smaller operative exposures associated with suturectomy for craniosynostosis may result in difficulties visualizing the prematurely fused suture during surgery. The authors report cases of suturectomy for lambdoid and metopic craniosynostosis in which neuronavigation or frameless stereotaxy was used to assist with incision planning and intraoperative localization of the fused suture. In both cases, neuronavigation integrated easily and safely into established workflows and was associated with complete suture release. To our knowledge, this is the first report of applying this noninvasive technology, which does not require cranial pinning or rigid fixation, to suturectomy, and the authors demonstrate its use as an adjunct, especially for surgeons beginning in practice. Larger studies are needed to determine if neuronavigation in suturectomy is associated with a clinically significant reduction in blood loss or operative time or an increase in the rate of complete suturectomy.

Operative Fractures of the Phalangeal Head and Neck in Children-Does Open Reduction Affect Outcomes?

Closed reduction percutaneous pinning of displaced pediatric phalangeal head and neck fractures is preferred to prevent malunion and loss of motion and function. However, open reduction is required for irreducible fractures and open injuries. We hypothesize that osteonecrosis is more common in open injuries than closed injuries that require either open reduction or closed reduction percutaneous pinning. Retrospective chart review of 165 phalangeal head and neck fractures treated surgically with pin fixation at a single tertiary pediatric trauma center from 2007 to 2017. Fractures were stratified as open injuries (OI), closed injuries undergoing open reduction (COR), or closed injuries treated with closed reduction (CCR). The groups were compared using Pearson χ 2 tests and ANOVA. Two group comparisons were made with Student t test. There were 17 OI fractures, 14 COR fractures, and 136 CCR fractures. Crush injury was the predominant mechanism in OI versus COR and CCR groups. The average time from injury to surgery was 1.6 days for OI, 20.4 days for COR, and 10.4 days for CCR. The average follow-up was 86.5 days (range, 0 to 1204). The osteonecrosis rate differed between the OI versus COR and OI versus CCR groups (71% for OI, 7.1% for COR, and 1.5% for CCR). Rates of coronal malangulation >15 degrees differed between the OI and COR or CCR groups, but the 2 closed groups did not differ. Outcomes were defined using Al-Qattan's system; CCR had the most excellent and fewest poor outcomes. One OI patient underwent partial finger amputation. One CCR patient had rotational malunion but declined derotational osteotomy. Open phalangeal head and neck fractures have more concomitant digital injuries and postoperative complications compared with injuries closed on presentation, regardless of whether the fracture underwent open or closed reduction. Although osteonecrosis occurred in all 3 cohorts, it was most frequent in open injuries. This study allows surgeons to discuss rates of osteonecrosis and resultant complications with families whose child presents with phalangeal head and neck fractures that are indicated for surgical treatment. Therapeutic, Level III.

Biomechanical evaluation of a novel biomimetic artificial intervertebral disc in canine cervical cadaveric spines.

Cervical disc replacement (CDR) aims to restore motion of the treated level to reduce the risk of adjacent segment disease (ASD) compared with spinal fusion. However, first-generation articulating devices are unable to mimic the complex deformation kinematics of a natural disc. Thus, a biomimetic artificial intervertebral CDR (bioAID), containing a hydroxyethylmethacrylate (HEMA)-sodium methacrylate (NaMA) hydrogel core representing the nucleus pulposus, an ultra-high-molecular-weight-polyethylene fiber jacket as annulus fibrosus, and titanium endplates with pins for primary mechanical fixation, was developed. To assess the initial biomechanical effect of the bioAID on the kinematic behavior of the canine spine, an ex vivo biomechanical study in 6-degrees-of-freedom was performed. A canine cadaveric biomechanical study. Six cadaveric canine specimens (C3-C6) were tested in flexion-extension (FE), lateral bending (LB) axial rotation (AR) using a spine tester in three conditions: intact, after C4-C5 disc replacement with bioAID, and after C4-C5 interbody fusion. A hybrid protocol was used where first the intact spines were subjected to a pure moment of ±1Nm, whereafter the treated spines were subjected to the full range of motion (ROM) of the intact condition. 3D segmental motions at all levels were measured while recording the reaction torsion. Biomechanical parameters studied included ROM, neutral zone (NZ), and intradiscal pressure (IDP) at the adjacent cranial level (C3-C4). The bioAID retained the sigmoid shape of the moment-rotation curves with a NZ similar to the intact condition in LB and FE. Additionally, the normalized ROMs at the bioAID-treated level were statistically equivalent to intact during FE and AR while slightly decreased in LB. At the two adjacent levels, ROMs showed similar values for the intact compared to the bioAID for FE and AR and an increase in LB. In contrast, levels adjacent to the fused segment showed an increased motion in FE and LB as compensation for the loss of motion at the treated level. The IDP at the adjacent C3-C4 level after implantation of bioAID was close to intact values. After fusion, increased IDP was found compared with intact but did not reach statistical significance. This study indicates that the bioAID can mimic the kinematic behavior of the replaced intervertebral disc and preserves that for the adjacent levels better than fusion. As a result, CDR using the novel bioAID is a promising alternative treatment for replacing severely degenerated intervertebral discs.

Comparison of Distal Radius Fracture Outcomes in Older Adults Stratified by Chronologic vs Physiologic Age Managed With Casting vs Surgery

Casting is recommended for adults older than 65 years with distal radius fractures (DRFs) because similar long-term outcomes are achieved regardless of treatment. However, physiologically younger adults could benefit from operative DRF management despite advanced chronologic age. To examine how chronologic age compares with measures of physiologic age in DRF treatment recovery. This retrospective secondary analysis of the Wrist and Radius Injury Surgical Trial (WRIST) was performed from May 1 to August 31, 2022. WRIST was a 24-center randomized clinical trial that enrolled participants older than 60 years with unstable DRFs from April 1, 2012, to December 31, 2016. Participants selected casting or surgery. Patients who selected surgery were randomly assigned to volar lock plating, percutaneous pinning, or external fixation. Participants were stratified by chronologic age, number of comorbidities, and activity status. The primary outcome was Michigan Hand Outcomes Questionnaire (MHQ) score assessed at 6 weeks, 3 months, 6 months, and 1 year. Partial correlation (PC) analysis adjusted for confounding. The final cohort consisted of 293 participants (mean [SD] age, 71.1 [8.89] years; 255 [87%] female; 247 [85%] White), with 109 receiving casting and 184 receiving surgery. Increased chronologic age was associated with increased MHQ scores in the surgery group at all time points but decreased MHQ scores in the casting group at 12 months (mean [SD] score, -0.46 [0.21]; P = .03). High activity was associated with improved MHQ scores in the surgical cohort at 6 weeks (mean [SD] score, 12.21 [5.18]; PC = 0.27; P = .02) and 12 months (mean [SD] score, 13.25 [5.77]; PC = 0.17; P = .02). Comorbidities were associated with decreased MHQ scores at all time points in the casting group. Clinically significant differences in MHQ scores were associated with low physical activity, 4 or more comorbidities, or increased age by 15 years. In this retrospective secondary analysis of WRIST, chronologic age was not associated with functional demand. These findings suggest that physicians should counsel active older adults with few comorbidities on earlier return to daily activities after surgery compared with casting. ClinicalTrials.gov Identifier: NCT01589692.

Hydroxyapatite-coated compared with stainless steel external fixation pins did not show impact in the rate of pin track infection: a multicenter prospective study.

Infection at the pin site remains the most common complication of external fixators (EFs). It is known that hydroxyapatite (HA)-coated pins increase bone adhesion and may lead to reduced rates of reported infections. The present study compares the rates of pin track infection associated with stainless steel and HA-coated pins. This is a prospective, multicenter, nonrandomized, comparative intervention study among patients undergoing surgical treatment with EFs of any type between April 2018 and October 2021. Patients were followed up until the removal of the EF, or the end of the study period (ranging from 1 to 27.6 months). The definition of pin track infection was based upon the Maz-Oxford-Nuffield (MON) pin infection grading system. Overall, 132 patients undergoing external fixation surgery were included. Of these, 94 (71.2%) were male, with a mean age of 36.9 years (SD ± 18.9). Infection of any type (score > 1) was observed in 63 (47.7%) patients. Coated and uncoated-pin track-infection occurred in 45.7% and 48.5% of patients, respectively (P= 0.0887). The probability of developing infection (defined as a score ≥ 2) adjusted for comorbidities and follow-up time was not statistically higher among those who received uncoated pins compared to those who received pins coated with HA (odds ratio (OR) = 1.56, 95% confidence interval (95% CI): 0.67-3.67, p <0.05). In the present study, the external fixator pin infection rates were similar when using HA coating and standard steel pins.

Analysis of Factors Influencing Thoracic Deformities after Median Sternotomy in Infants Who Underwent Congenital Cardiac Surgery

Objective. To investigate the incidence of thoracic deformities after median sternotomy in infants who underwent congenital cardiac surgery and determine its influencing factors. Methods. This was a single-center retrospective study. A total of 156 infants who underwent congenital cardiac surgery with median sternotomy in a provincial hospital in China from September 2020 to January 2022 were included. Depending on whether thoracic deformities occurred, the patients were classified into the thoracic deformity group and the no thoracic deformity group. Relevant data were retrieved through an electronic medical record system, and statistical comparisons and analyses were performed. Results. The incidence of postoperative thoracic deformities in this cohort was 10.9%. Sternal pins for auxiliary sternal fixation were used in eighty-nine infants. After analysis, it was found that age at operation (1.9 ± 0.9 vs. 3.7 ± 1.2, P &lt; 0.001 ) and weight-for-age Z-scores (−2.0 ± 0.7 vs. −1.4 ± 0.7, P = 0.001 ) of the thoracic deformity group were significantly lower than those of the no thoracic deformity group. In addition, sternal pin use was significantly higher in the no thoracic deformity group than in the thoracic deformity group (61.9% vs. 17.6%, P = 0.001 ). Univariable analysis showed that age at operation (OR, 4.74; 95% CI, 2.38–9.46; P &lt; 0.001 ) and weight-for-age Z-scores (OR, 4.40; 95% CI, 1.74–11.12; P = 0.002 ) were significant risk factors for postoperative thoracic deformity. Using sternal pins for auxiliary sternal fixation was an important protective factor (OR, 7.57; 95% CI, 2.08–27.59; P = 0.003 ). Conclusions. In this study, 10.9% of infants undergoing congenital cardiac surgery through a median sternotomy developed thoracic deformities after surgery. Younger age at operation and poor nutritional conditions may be risk factors for postoperative thoracic deformity. Sternal pin-assisted fixation has a positive effect on the prevention of thoracic deformities.

Effects of multiwavelength photobiomodulation for the treatment of traumatic soft tissue injuries associated with bone fractures: A double-blind, randomized controlled clinical trial.

This study evaluated the efficacy and safety of multiwavelength photobiomodulation (MPBM) in healing soft tissue injuries associated with tibial and/or ankle fractures. Participants were randomized into the MPBM or control group. Primary outcome was wound healing, measured by the Bates-Jensen scale. Assessments were performed daily. Twenty-seven hospitalized adults were included. MPBM showed an improvement in the daily mean Bates-Jensen scale (MPBM 32.1 vs. control 34.2; p=0.029), daily mean pain score change (MPBM 0.5 vs. control 0.2; p=0.04) and occurrence of infection at the site of the external fixator pins (MPBM 15.3% vs. control 57.1%; p=0.02). MPBM group also showed faster-wound resolution (MPBM 13.1 vs. control 23.1 days). Subgroup analysis showed improvement in the MPBM group among less severe patients on the Bates-Jensen scale (MPBM 27.4 vs. control 34.7; p=0.0081) and mean time for wound resolution (MPBM 7.0 vs. control 14.6 days; p=0.03). MPBM appears safe and effective in reducing wound resolution time, infection in the surgical pin sites, reported pain and time before definitive surgery.

Fixation Pins Increase the Accuracy of Implant Surgery in Free-End Models: An In Vitro Study

Implant surgical guides, in combination with implant planning software, have been designed for accurate surgery, especially in partial edentulism. The purpose of this study was to examine the effect of fixation pins of surgical guides on the accuracy of static computer-assisted implant surgeries in a maxillary free-end situation. This invitro study was conducted to compare surgical guides using various fixation pin protocols in implant surgery. A patient dental model with missing teeth from maxillary right first premolar to third molar was used as the study model… Implant placement was planned at maxillary right first premolar, right first molar, and right second molar; Straumann full guide templates were designed and fabricated using the coDiagnostiX software. The experiment involved surgical guides with no fixation pins (NF), buccal unilateral fixation pin (BF), palatal unilateral fixation pin (PF), and bilateral fixation pins on the buccal and palatal sides (BPF), based on the position and number of fixation pins. The deviation between the actual and planned positions was used to evaluate implant accuracy. The fixation pin protocols were the primary predictive variables. Angular, 3D platform, and 3D apex deviations were the primary outcome variables. Statistical analysis was performed using the one-way analysis of variance and Tukey's test (α=0.05). NF generated the maximum angular deviation (3.65±1.39°), 3D platform deviation (1.58±0.55mm), and 3D apex deviation (2.18±0.79mm), whereas BPF produced the minimum angular deviation (1.88±0.86°), 3D platform deviation (1.09±0.51mm), and 3D apex deviation (1.53±0.45mm). A statistically significant difference between NF and BPF in the angular deviation, 3D platform, and apex deviation (P<.0001, P=.009, and P=.002, respectively) was identified. The unilateral fixation pin exerted a significant effect only on the angular accuracy (BF, P=.0018; PF, P=.0001). In a maxillary free-end situation, templates with a fixation pin generate better implant accuracy than those without it. A bilateral fixation pin protocol may produce less deviation than those without fixation pins. The implant accuracy does not appear to be affected by the position of the unilateral fixation pin.

A Comparison of Outcomes following Plate versus Pin Fixation of Metacarpal Shaft and Neck Fractures.

Electronic medical records at two institutions were reviewed for patients who underwent surgical intervention for metacarpal fractures. Data were collected from those who underwent reduction and internal fixation with either plates or Kirschner wires (K-wires). Inclusion criteria included minimum postoperative follow-up of 60 days and age 18 years or older. Exclusion criteria included insufficient radiographic data, previously attempted closed reduction with immobilization, pathologic fracture mechanism, history of previous trauma or surgery to the affected bone, and fixation technique other than plate or K-wire. We reviewed data for patients treated over a 22-year time period. Ultimately, 81 metacarpal shaft and neck fractures in 60 patients met inclusion criteria. Among all metacarpal fractures, complications were present in 39 (48.1%) cases. There were no significant associations between complication prevalence and hardware type. Revision surgery was required in 11 (13.6%) patients; there were no significant associations between revision procedures and hardware type. Postoperatively, all patients with imaging data had radiograph follow-up to assess union status. There was no significant association between time to union and hardware type. Outcomes showed no significant difference between plate and pin fixation for metacarpal shaft and neck fractures. These findings suggest that surgeons may have flexibility to decide on the type of operative intervention while considering patient-specific factors, such as the need for early mobilization.

Excision with Temporary Interphalangeal Joint Pin Fixation for Toe Ganglion Cysts.

Toe ganglion cysts are often symptomatic and recurrent. Communicating lesions between ganglion cysts and the interphalangeal joint (IPJ) or tendon sheath make it difficult to prevent a recurrence. Temporary restriction of the joint and tendon motion can facilitate surgical site healing. This study analyzed the clinical results of temporary pin fixation of the IPJ after toe ganglion cyst excision. Sixteen patients with symptomatic toe ganglion cysts underwent surgical treatment. Excision alone was initially performed on 10 patients. Six patients underwent temporary pin fixation of the IPJ after ganglion cyst excision. Repeat excision with pin fixation was performed for recurrence in two patients after excision only. Clinical evaluations and postoperative complications were analyzed. Fourteen of 16 toe ganglion cysts were located near the IPJ. Two cysts not adjacent to the joint completely healed after excision alone. Seven of 14 cysts near the joint recurred after initial excision alone and required repeated reoperation. Eight cysts did not recur after excision with pin fixation, including 2 that recurred after excision alone. Temporary IPJ pin fixation after excision for ganglion cysts can be effective for preventing the recurrence of ganglion cysts adjacent to toe IPJ.

Outcomes of the Pin and Plate Technique in Complex Fractures and Nonunions of Distal Humerus.

This study investigates outcomes and complications of the pin and plate fixation technique, which was suggested for distal humerus fractures. It also reports the results of its application in nonunions for the first time. Forty-nine fracture and 17 nonunion cases who underwent surgery using the technique and were followed for at least 18 months were assessed through the range of motion (ROM), Quick Disabilities of the Arm, Shoulder, and Hand Score (Quick-DASH), Mayo Elbow Performance Score (MEPS), four-category verbal rating scale (VRS-4), and complications. At the last follow-up, the mean scores of flexion, extension deficit, supination, and pronation ranges in fracture cases were 116.7, 22.9, 90.0, and 90.0 degrees, respectively. These values in nonunion cases were 112.2, 26.4, 86.7, and 85.5 degrees, respectively. The average ROM in fracture cases was 93.8, while it was 85.8 degrees in nonunion cases. The mean Quick-DASH in fracture and nonunion patients were 25.2 and 31.1, respectively. According to the MEPS, 77.5% of fracture and 64.7% of nonunion patients had excellent and good results. In fracture cases, the mean scores of VRS-4 at rest, light activity, and hard activity were 1.3, 1.8, and 2.3, respectively. These values in nonunion cases were 1.8, 2.2, and 2.5, respectively. The most common complications were device prominence and ulnar neuropathy. An acceptable union rate and proper elbow function can be expected by using this technique. Owing to the promising results of this study, further high-quality studies are recommended. Hereby this technique is called Persian Fixation.

Early Surgical Results of Pediatric Unicondylar Phalangeal Fractures

Conventional teaching dictates that timely diagnosis and expeditious treatment of unicondylar phalangeal fractures are essential to restore articular congruity, which allows for optimal range of motion and function. The objective of this study was to compare the radiographic and clinical results of surgical treatment of acute and chronic unicondylar phalanx fractures in pediatric patients. Thirty-four patients with unicondylar phalangeal fractures underwent surgical intervention at a pediatric tertiary care center from 2004 to 2016. A fracture was defined as acute if an interval of 4 weeks or less had elapsed between the date of injury and date of surgery and chronic if an interval of more than 4 weeks had elapsed between the date of injury and date of surgery. Preoperative and postoperative radiographs were assessed. The joint alignment was determined by measuring the angle between the longitudinal axis of the phalanx and a line tangential to the articular condyles on anteroposterior radiographs. There were 24 patients (71%) with acute and 10 (29%) with chronic fractures. An oblique volar fracture pattern was most common in both the groups. The average joint alignment obtained from the anteroposterior radiographs at presentation was 6° in the acute group and 12° in the chronic group. The surgical procedures performed included closed reduction and percutaneous pinning, open reduction and internal fixation, osteoclasis or osteotomy and fixation, and corrective advancement osteotomy. The posttreatment alignment was within 3° of neutral in 21 patients (88%) with acute injury and 8 (80%) with chronic injury. The average interphalangeal joint range of motion at the final clinic visit was 1°-92° in the acute group and 4°-85° in the chronic group. One patient with chronic injury developed avascular necrosis after treatment with corrective osteotomy. The patterns and characteristics of unicondylar phalanx fractures are similar between pediatric patients and adults. The radiographic alignment and digital motion are improved with surgical reduction and fixation, regardless of chronicity. Therapeutic IV.