Hydroxyapatite-coated Pins Research Articles

Techniques and Considerations for the Operative Treatment of Ankle Fractures in the Elderly.

* In managing fragility fractures about the ankle, nonoperative treatment should be considered with the caveat that soft-tissue integrity is of the utmost importance.* Consultation with medical and nutritional services for the comanagement of elderly patients with a fragility ankle fracture improves outcomes.* Soft-tissue preservation in the elderly is optimized with the judicious use of a tourniquet.* In elderly patients, a congruent ankle joint with axial alignment and stability should be emphasized over achieving anatomic articular reduction.* Less invasive surgical techniques, such as percutaneously placed anterior-to-posterior screws for posterior malleolar fractures and intramedullary fibular fixation, should be considered in the elderly.* Construct stability in elderly patients is maximized with the use of lateral locking plates, tibia-pro-fibula screws, and bicortical medial malleolar screws.* The use of external fixation with hydroxyapatite-coated pins should be considered in the treatment algorithm for fragility ankle fractures in elderly patients.

Bone remodelling in a conservative femoral component for hip replacement surgery

This study investigated a conservative femoral component for hip replacement surgery. Re-surfacing implants with two hydroxyapatite-coated pins were inserted into the right femoral necks of eight adult goats for one year. Radiographic analysis revealed bone loss directly beneath the prosthetic cup with increased amounts of bone at the distal end of the pins. Microscopic analysis revealed localised areas of bone formation adjacent to the implant. Oxytetracycline bone markers demonstrated significantly decreased bone formation rates (p<0.05) in bone adjacent to the implant in the operated compared to the control hips. Image analysis results demonstrated an average bone attachment of 30.94% to the implant surface. Attachment varied regionally, with greatest bone attachment at the end of the pins (78.99%) contributing 22% of total bone attachment to the implant. Least bone attachment (13.82%) was measured beneath the prosthetic cup and adjacent to the medial aspect of the pin. This contributed 4% of total bon...

A systematic review of incidence of pin track infections associated with external fixation

Depending on the reference, pin track infection rates in external fixation surgery have been stated to be anywhere from 0% to 100%. We critically evaluated the pin track infection rate for external fixation by performing systematic review of the external fixation literature since 1980. Using PubMed, a search of the peer-reviewed literature on external fixation was performed. This systematic review was conducted, as much as possible, in accordance with PICOS and PRISMA guidelines. A total of 150 articles were reviewed, including at least one from each year between 1980 and 2014. The following data were collected from each article: the year of publication, number of patients in the study, average age of the patients, reason for the external fixation, fixation per segment (two or more than two points), body part involved, whether or not hydroxyapatite-coated pins were used, duration of the external fixator, type of fixator used, and number of patients with documented pin track infections. These 150 studies represented 6130 patients. There were 1684 reported pin track infections from these 6130 patients, giving a cumulative pin track infection rate of 27.4%. A more recent year of publication was associated with an increasing infection rate (P = 0.015) while increasing age was associated with a decreased infection rate (P < 0.0005). There were trends toward association of humerus location (P = 0.059), shorter fixator duration (P = 0.056), and circular fixation (P = 0.079) with decreased infection rates. This systematic review of external fixation publications revealed a cumulative pin track infection rate of 27%. Younger age was the factor leading to increased pin track infection rates. Circular fixation trended toward being protective of pin track infection when usage was factored into the multiple regression analysis. Longer duration of fixation trended toward increased infection rate as expected. This data provides important base values for a common complication in external fixation treatment, highlights the importance of a more consistent definition of a pin track infection in future research, and identifies the pediatric population as the group at greatest risk.

Safe Cosmetic Leg Lengthening for Short Stature: Long-term Outcomes.

It is well known that limb lengthening is performed to treat limb-length discrepancies resulting from congenital anomalies and developmental problems. However, few studies discuss lengthening for cosmetic purposes. The current authors conducted a prospective study with long-term follow-up. From July 2002 through June 2007, 133 patients requested that their height be increased. Fifty-two were approved to undergo limb-lengthening surgery. Two were lost to final follow-up, leaving 50 in the study group. For all patients, the Ilizarov ring external fixator was applied with a maximum-stability technique that achieved frame stability and allowed patients to ambulate with a walker from the first week postoperatively. The method requires close follow-up for early detection of problems. Physiotherapy improved ankle function and prevented plantar flexion deformity, which can occur during lengthening. Excellent final outcomes were achieved in all patients except one, who required additional surgery. The Ilizarov device is a safe tool for limb lengthening in individuals of short stature when applied with the authors' maximum stability technique. To the authors' knowledge, this is the first article on this topic to report long-term results (minimum 5-year follow-up for all patients). Many factors influence the outcome of lengthening surgery performed with Ilizarov devices: the material of the rings, the use of a hybrid technique combining pins and wires, the diameter and number of pins over each bone segment, the size of the rings around the limb, the surgical technique for pin insertion, and the use of hydroxyapatite-coated pins or regular stainless pins.

Effect of asymmetrical configuration of pins in the TSF external fixator used for tibial lengthening in a pediatric population.

The Taylor Spatial Frame (TSF) is a relatively new circular external fixator linked with a computer program used in limb reconstruction surgery. It is routinely used in our unit (Royal Manchester Children's Hospital) for pediatric tibial lengthening. The case notes and radiographs of 17 children who underwent 18 tibial lengthenings were reviewed. The TSF was attached to the tibia using a hybrid fixation method in the safe zone with two 1.8 mm tensioned smooth wires and 2 anteriorly placed hydroxyapatite-coated pins. Mechanical compression testing of our TSF construct was performed and compared with a double-ring Ilizarov frame construct fixed with only tensioned wires. Out of the 18 tibiae lengthened 14 (77.8%) had a significant anterior angulation (>10 degrees) at the end of the distraction period that was corrected with a residual TSF program, with no known long-term consequences. The mechanical tests showed that the Ilizarov frame showed a more symmetrical distribution of loading in compression when compared with the TSF. With increasing load the TSF had the tendency to angulate anteriorly, that is, the apex of the angulation was pointing toward the 2 pins. The problem of anterior angulation observed in our clinical and mechanical studies is due to instability of the fixation of the proximal part of the frame. Surgical techniques that can improve the stability of the proximal fixation and promote symmetrical loading are discussed.

Bisphosphonate-coated external fixation pins appear similar to hydroxyapatite-coated pins in the tibial metaphysis and to uncoated pins in the shaft

Background and purpose External fixation pins tend to loosen with time, especially from cancellous bone. A coating that releases a bisphosphonate has been shown to improve the fixation of dental implants in humans. We now tested a bisphosphonate coating on steel pins for external fixation. The primary hypothesis was that coated pins would be better fixed in the diaphysis.Methods 20 patients with medial knee osteoarthritis underwent proximal tibial correction osteotomy with hemicallotasis. They received a pair of pins (Orthofix) in the tibial shaft, one bisphosphonate-coated and one uncoated. Another pair of pins was inserted in the metaphysis, near the joint. This pair was a bisphosphonate-coated pin and an HA-coated pin. All pins were inserted according to a random list. The pins were removed after the osteotomy had healed (8–15 weeks), and extraction torque served as the predetermined main outcome variable.Results No pins showed clinical signs of loosening. Removal torque for the shaft pins was 6.6 Nm (SD 2.2) for the bisphosphonate and 6.0 Nm (SD 2.5) for the uncoated (difference = 0.5, 95% CI: –0.03 to 1.3). Removal torque for the metaphyseal pins was 4.4 Nm (SD 1.3) for the bisphosphonate-coated and 4.2 Nm (SD 1.6) for the HA-coated (difference = 0.2, 95% CI: –0.5 to 1.0).Interpretation We could not show any improved cortical fixation, but the metaphyseal findings are striking. In a previous study on 19 patients with a similar layout, HA-coated and uncoated pins were compared. In the metaphysis, all 19 uncoated pins loosened before removal. It was concluded that uncoated pins could not be used in the metaphyseal region. The present results suggest that a bisphosphonate coating enables metaphyseal fixation similar to that of hydroxyapatite coatings, with no difference from uncoated pins in cortical bone.

Comparison of hydroxyapatite-coated and uncoated pins for transfixation casting in horses

To determine the extent to which a hydroxyapatite coating promotes pin stability in the third metacarpal bone during transfixation casting in horses. 14 adult horses. 7 horses each were assigned to either an uncoated or hydroxyapatite-coated pin group. Three transcortical pins were placed in the third metacarpal bone of each horse and incorporated into a cast for 8 weeks. Insertion and extraction torque were measured, and torque reduction was calculated. Radiography was performed at 0, 4, and 8 weeks. Lameness evaluation was performed at 2, 4, 6, and 8 weeks. Bacteriologic culture of pins and pin holes was performed at pin removal. All horses used casts without major complication throughout the study. Insertion torque was higher in uncoated pins. There was no effect of group on extraction torque. Hydroxyapatite-coated pins had lower torque reduction. Five of 15 hydroxyapatite-coated pins maintained or increased stability, whereas all uncoated pins loosened. Pin hole radiolucency, lameness grades, and positive bacteriologic culture rates were not different between groups. Hydroxyapatite coating increased pin stability within the third metacarpal bone of horses during 8 weeks of transfixation casting but did not improve pin performance on clinical assessments. Clinical use of hydroxyapatite-coated transfixation pins may result in greater pin stability; however, further research is necessary to improve the consistency of pin osteointegration and elucidate whether clinical benefits will ultimately result from this approach in horses.

Hydroxyapatite-Coated Pins Versus Titanium Alloy Pins in External Fixation at the Wrist: A Controlled Cohort Study

The purpose of this study was to analyze whether the prevalence of pin-related complications can be reduced by the use of hydroxyapatite (HA)-coated pins in external fixators applied for unstable wrist fractures. Forty patients (160 pins) were randomized for standard uniplanar fixator treatment with the use of identically designed pins either composed of titanium-alloy (Ti6Al4V) (n = 20) or coated by HA (n = 20). Each pin site was clinically evaluated with regard to erythema, drainage, pain value, and radiologically assessed concerning loosening at T1 (mean, 9 days), T2 (mean, 43 days), and T3 (mean, 56 days). In case of pin-track complication, the patient was followed continuously. The need for antibiotics or additional surgery was documented. Bone mineral density was analyzed by Dual Energy X-ray Absorptiometry. At fixator removal (T2), the pin-extraction strength was measured by the use of a digital-torque-wrench. Two minor pin-track infections requiring oral antibiotics occurred in the HA-pin group (2.7%) (p > 0.05). The vast majority of clinical pin-site parameters were comparable in both groups. At the end of the fixator therapy, there were 16 loose pins (n(Ti6AL4V-group) = 10; n(HA-group) = 6). The rate of loose pins was correlated to patient's age (p < 0.05) but not to bone mineral density values or the occurrence of pin-site infection. Finally, no significant difference between the two groups was detected with regard to the prevalence of clinical relevant pin-site complications (p = 0.80). In external fixation of the wrist, the use of HA-coated pins yields no clinical advantages: there is a trend toward a superior pin-bone anchorage, but a tendency of increased susceptibility for minor pin-track infections.

Clinical benefit of hydroxyapatite-coated pins compared with stainless steel pins in external fixation at the wrist: A randomised prospective study

Background The purpose of this study was to determine the clinical benefit of hydroxyapatite (HA)-coated pins compared with standard stainless steel pins in external fixators applied for unstable fractures of the distal radius. Methods A total of 40 patients (160 pins) with unstable wrist fractures were randomised for uniplanar fixator treatment with the use of identically designed, commercially available pins either composed of stainless steel (steel group) ( n = 20) or coated by hydroxyapatite (HA group) ( n = 20). Each pin site was clinically evaluated concerning erythema and grade of drainage as well as pain intensity (numeric rating scale (NRS) 0–10) and, additionally, radiological assessment was performed concerning pin-loosening/infection as well as fracture healing at T1 (Ø18 days), T2 (Ø44 days) and T3 (Ø65 days). In case of pin-track complication, the patient was followed continuously. The need for intensified pin-site care, oral or intravenous antibiotic medication, re-admission for additional surgery and premature fixator removal was documented. Bone mineral density (BMD) was determined by dual energy X-ray absorptiometry. At fixator removal (T2), the pin-extraction strength was measured by the use of an electronic torque wrench. Results Two pin-track infections requiring daily pin-site care and oral antibiotics occurred in the HA group (2.6%) compared with four in the steel group (5.3%) ( p = 0.601) and although a trend towards a superior performance of HA pins was detectable, the majority of clinical pin-site-parameters were comparable in both groups. At the end of the fixator therapy, the HA group showed a non-significant lower rate of loose pins ( n steel group = 9; n HA group = 6; p = 0.864) and both hydroxyapatite-coated pins showed at the radius a significantly stronger pin-bone bonding measured by the torque wrench ( p proximal radius pin = 0.007; p distal radius pin = 0.031). Except for elderly patients of the steel group ( p = 0.018), all demographic-, health- and injury-related data including BMD were not correlated to any type of pin-site complication in both groups ( p > 0.05). Since all fracture healed uneventfully without any type of additional surgery, the number of patients suffering clinically relevant pin-related complications showed no significant difference between both groups ( p = 0.707). Conclusions The use of HA-coated pins compared with standard stainless-steel pins in external fixation for unstable wrist fractures yields only a trend towards a superior clinical outcome.

A single dose zoledronic acid enhances pin fixation in high tibial osteotomy using the hemicallotasis technique. A double-blind placebo controlled randomized study in 46 patients

IntroductionBisphosphonates have been shown to reduce osteoclastic activity and enhance pin fixation in both experimental and clinical studies. In this prospective, randomized study of high tibial osteotomy using the hemicallotasis (HCO) technique, we evaluate whether treatment by one single infusion of zoledronic acid can enhance the pin fixation. Materials and methods46 consecutive patients (35–65 years) were operated on for knee osteoarthritis by the HCO technique. After the osteotomy, two hydroxyapatite-coated pins were inserted in the metaphyseal bone and two non-coated pins in the diaphyseal bone. The insertion torque was measured by a torque force screw driver. Four weeks postoperatively, the patients were randomized to either one infusion of zoledronic acid or sodium chloride intravenously. At time for removal of the pins, the extraction torque forces of the pins were measured. ResultsAll osteotomies healed and no difference was found in time to healing. The mean extraction torque force in the non-coated pins in the diaphyseal bone was doubled in the zoledronic treated group (4.5 Nm, SD 2.1) compared to the placebo group (2.4 (SD 1.0, p<0.0001). The mean extraction torque forces of the hydroxyapatite-coated pins in the metaphyseal bone were similar in the zoledronic acid group (4.7 Nm, SD 1.3) and in the placebo group (4.0 Nm, SD 1.3). DiscussionA single infusion of zoledronic acid improved twofold the fixation of non-coated pins in diaphyseal bone. Bisphosphonates might be an alternative to hydroxyapatite-coated pins in nonosteoporotic bone.

Inferior fixation with a new pin design for external fixation: A randomized study in 50 patients operated on by the hemicallotasis technique

Background and purpose Tibial osteotomy by the hemicallotasis technique (HCO) requires strong pin fixation. We compared pin fixation in HCO using a new self-drilling XCaliber pin (Orthofix) with optimized thread and tip design, with the commonly used standard pin (Orthofix).Patients and methods 50 patients, mean age 51 (35–66) years, to be treated by HCO were randomized to standard pins or XCaliber pins. In the metaphyseal bone, hydroxyapatite-coated (HA-coated) pins were used in both types of pins. In the diaphyseal bone, non-coated pins were used. The torque forces for insertion and extraction (in Nm) were measured.Results The insertion torque was higher for both the proximal and distal standard pins (2.1 Nm (SD 0.9) and 7.0 Nm (1.3), respectively) than for the XCaliber pins (1.3 Nm (0.8) and 3.6 Nm (1.4)). The extraction torque force was higher for the proximal standard pins (4.3 Nm (3.1)) than for the proximal XCaliber pins (1.5 Nm (1.7)) (p < 0.001). The extraction torque for the distal standard pins was 1.9 Nm (2.0) and for the distal XCaliber pins it was 1.4 Nm (1.1).Interpretation The commonly used standard pin gives stronger fixation during the treatment of HCO.

No clinical benefits using a new design of pins for external fixation: a randomized study in 50 patients operated on by the hemicallotasis technique

Pin-site infection and pin loosening are complications that can cause discomfort to the patients. The purpose of present study was to evaluate pin-site infection, pain, and the use of medications using the XCaliber pin (Orthofix) with optimized thread and tip design, and the commonly used standard pin (Orthofix) during the procedure of hemicallotasis osteotomy (HCO). Fifty patients of mean age 51 (35-66) years treated with HCO were randomized to standard pins (Orthofix) or XCaliber pins (Orthofix). Hydroxyapatite-coated pins were used in the metaphyseal bone and non-coated pins in the diaphyseal bone in both groups. Pin sites, pain, and the use of medications were evaluated weekly during the HCO. At week 7 the patients in the XCaliber group had more pain at rest [19 (22) vs. 5 (5) mm, P = 0.01] and during activity [32 (32) vs. 12 (13) mm, P = 0.02] and used more paracetamol (2,100 vs. 925 mg, P = 0.04) than those in the standard group, with similar differences, until the extraction of the pins. There was no difference in the use of antibiotics [10.5 (14.5) days (XCaliber) vs. 7 (7.5) days (standard) (P = 0.16)]. The commonly used standard pin has important clinical- and patient-related benefits.

Alendronate Improves Screw Fixation in Osteoporotic Bone

Animal studies have demonstrated the efficacy of the use of bisphosphonates to enhance screw fixation in bone. In this prospective, randomized study of pertrochanteric fractures treated with external fixation, we tested whether systemic administration of bisphosphonates would improve the fixation of hydroxyapatite-coated screws implanted in osteoporotic bone. Sixteen consecutive patients with a pertrochanteric fracture were selected. Inclusion criteria were female gender, an age of at least sixty-five years, and a bone mineral density T-score of less than -2.5 standard deviations. Exclusion criteria included bisphosphonate treatment during the two-year period prior to the fracture. Fractures were fixed with a pertrochanteric fixator and four hydroxyapatite-coated pins. Two pins were implanted in the femoral head (pin positions 1 and 2), and two were placed in the femoral diaphysis (pin positions 3 and 4). The patients were randomized either to therapy with alendronate for a three-month postoperative period (Group A) or to no therapy (Group B). The Group-A patients received an oral dose of 70 mg of alendronate per week. The fixators were removed after three months. All of the fractures healed, and no loss of reduction, nonunion, or delayed union was observed. The combined mean extraction torque (and standard deviation) of the pins implanted at positions 1 and 2 (cancellous bone) was 2558 +/- 1103 N/mm in Group A and 1171 +/- 480 N/mm in Group B (p < 0.0005). The combined mean extraction torque of the pins implanted at positions 3 and 4 (cortical bone) was 4327 +/- 1720 N/mm in Group A and 4075 +/- 1022 N/mm in Group B. These data show that weekly systemic administration of alendronate improves pin fixation in cancellous bone in elderly female patients with osteoporosis. We observed a twofold increase in extraction torque with the pins implanted in cancellous bone. These results support the use of alendronate in the treatment of osteoporotic pertrochanteric fractures to improve screw fixation in the femoral head.

Alendronate Improves Screw Fixation in Osteoporotic Bone

Background: Animal studies have demonstrated the efficacy of the use of bisphosphonates to enhance screw fixation in bone. In this prospective, randomized study of pertrochanteric fractures treated with external fixation, we tested whether systemic administration of bisphosphonates would improve the fixation of hydroxyapatite-coated screws implanted in osteoporotic bone. Methods: Sixteen consecutive patients with a pertrochanteric fracture were selected. Inclusion criteria were female gender, an age of at least sixty-five years, and a bone mineral density T-score of less than –2.5 standard deviations. Exclusion criteria included bisphosphonate treatment during the two-year period prior to the fracture. Fractures were fixed with a pertrochanteric fixator and four hydroxyapatite-coated pins. Two pins were implanted in the femoral head (pin positions 1 and 2), and two were placed in the femoral diaphysis (pin positions 3 and 4). The patients were randomized either to therapy with alendronate for a three-month postoperative period (Group A) or to no therapy (Group B). The Group-A patients received an oral dose of 70 mg of alendronate per week. The fixators were removed after three months. Results: All of the fractures healed, and no loss of reduction, nonunion, or delayed union was observed. The combined mean extraction torque (and standard deviation) of the pins implanted at positions 1 and 2 (cancellous bone) was 2558 ± 1103 N/mm in Group A and 1171 ± 480 N/mm in Group B (p < 0.0005). The combined mean extraction torque of the pins implanted at positions 3 and 4 (cortical bone) was 4327 ± 1720 N/mm in Group A and 4075 ± 1022 N/mm in Group B. Conclusions: These data show that weekly systemic administration of alendronate improves pin fixation in cancellous bone in elderly female patients with osteoporosis. We observed a twofold increase in extraction torque with the pins implanted in cancellous bone. These results support the use of alendronate in the treatment of osteoporotic pertrochanteric fractures to improve screw fixation in the femoral head. Level of Evidence: Therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.

A contemporary snapshot of the use of hydroxyapatite coating in orthopaedic surgery

The capacity for biological materials to combine with inorganic salts is well established. Bio-mineralisation was an evolutionary milestone, and a key contributor to the ‘cladogenesis of life’ which occurred in the early Cambrian period, 570 million years ago.[1][1] A protracted ice age in the

Hydroxyapatite-coated external fixation pins

The aim of this review is to report on studies of hydroxyapatite-coated external fixation pins as a solution to enhance pin fixation. In a highly loaded animal study, three tapered pin types were compared: Type A uncoated, Type B coated with hydroxyapatite and Type C coated with titanium. There was a 13-fold increase in the extraction torque of Type B pins compared with Type A, and a twofold increase compared with Type C pins. Extraction torque was significantly lower compared with the corresponding insertion torque in both Types A (p < 0.001) and C (p = 0.003). Conversely, with the hydroxyapatite-coated pins there was no difference between extraction and insertion torque. In a clinical study of 76 external fixation pins in 19 patients treated with hemicallotasis for osteoarthritis on the medial side of the knee, pin insertion and extraction torque forces were measured. The patients were randomized to be treated with either standard tapered pins or tapered pins coated with hydroxyapatite. Extraction torque of the hydroxyapatite-coated pins was higher than the extraction torque of the standard pins in both cancellous and cortical bone (p < 0.005). In a prospective, randomized clinical study of osteoporotic wrist fractures, extraction torque of the coated pins was higher than with standard pins (p < 0.0001). These studies demonstrate that with the use of hydroxyapatite-coated pins, no deterioration of pin fixation occurs, and that there is no significant pin loosening and infection, regardless of bone type and loading conditions.

Comparing Dynamic Hip Screw to External Fixation for Treatment of Osteoporotic Pertrochanteric Fractures: A Prospective Randomized Study

External fixation has proven to be a viable minimally invasive treatment option for elderly patients with trochanteric fractures. Postoperative complications has limited external fixation in relation to inadequate pin fixation. We compared Orthofix pertrochanteric fixator (OPF) with hydroxyapatite-coated pins to dynamic hip screw (DHS) with AO/ASIF stainless-steel screws in osteoporotic trochanteric fractures. Methods: Forty patients were divided into two groups and randomized for treatment with 135° 4-hole DHS (Group A) or OPF with four hydroxyapatite-coated pins (Group B). Inclusion criteria was: female, age ≥ 65 years, AO fracture type A1 or A2 and BMD lower than -2.5 T-score. All fixators were removed at 3 months. Results: There were no differences in patient age, fracture type, BMD, ASA, hospital stay and reduction quality. Average number of blood transfusions was 2.0 ± 0.1 in Group A, whereas there were none in Group B (p &lt; 0.0001). Operative time was 64 ± 6 minutes in Group A and 34 ± 5 in Group B (p &lt; 0.005). Post-operative femoral neck shaft angle was 134 ± 6° in Group A, and 132 ± 4° in Group B (ns). In Group A, fracture varization at 6 months was 6 ± 8°, in Group B 2 ± 1° (p = 0.002). Harris hip score was 62 ± 20 in Group A and 63 ± 17 in Group B. (n.s.) In Group B, no pin infection occurred. Pin fixation was maintained over time, as shown by no significant difference between pin extraction and corresponding insertion torque. Discussion and Conclusion: In external fixation with hydroxyapatite-coated pins there was no need for blood transfusions and fixation was superior, as confirmed by less varization at long-term.

DYNAMIC HIP SCREW COMPARED WITH EXTERNAL FIXATION FOR TREATMENT OF OSTEOPOROTIC PERTROCHANTERIC FRACTURES

Background: Although the use of a sliding hip screw is considered to be the preferred treatment for pertrochanteric femoral fractures, we theorized that external fixation could produce clinical outcomes equal to, if not better than, the outcomes obtained with conventional treatment. Furthermore, because external fixation is minimally invasive, we expected a lower rate of morbidity and a reduced need for blood transfusions. Therefore, we compared the two treatments in a clinical trial of elderly patients with pertrochanteric fracture. Methods: Forty consecutive elderly female patients who had a pertrochanteric fracture were randomized to be treated with either fixation with a 135° four-hole sliding hip screw (Group A) or an external fixation device with hydroxyapatite-coated pins (Group B). The inclusion criteria were female gender, an age of at least sixty-five years, an AO/OTA type-A1 or A2 fracture, and a bone mineral density T-score of less than -2.5. There were no differences in patient age, fracture type, bone mineral density, comorbidities, length of hospital stay, or quality of reduction between the two groups. Results: The average intraoperative time (and standard deviation) was 64 ± 6 minutes in Group A and 34 ± 5 minutes in Group B (p < 0.005). The average number of units of blood transfused postoperatively was 2.0 ± 0.1 in Group A and none in Group B (p < 0.0001). Group B had less pain five days postoperatively (p < 0.05). Varus collapse of the fracture at six months averaged 6° ± 8° in Group A and 2° ± 1° in Group B (p < 0.002). No pin-track infections occurred in Group B. The average Harris hip score at six months was 62 ± 19 points in Group A and 63 ± 17 points in Group B. Conclusions: This study showed that external fixation with hydroxyapatite-coated pins is an effective treatment for this fracture in this patient population. The operative time is brief, the blood loss is minimal, the fixation is adequate, and the reduction is maintained over time. Level of Evidence: Therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.

Dynamic Hip Screw Compared with External Fixation for Treatment of Osteoporotic Pertrochanteric Fractures

Although the use of a sliding hip screw is considered to be the preferred treatment for pertrochanteric femoral fractures, we theorized that external fixation could produce clinical outcomes equal to, if not better than, the outcomes obtained with conventional treatment. Furthermore, because external fixation is minimally invasive, we expected a lower rate of morbidity and a reduced need for blood transfusions. Therefore, we compared the two treatments in a clinical trial of elderly patients with pertrochanteric fracture. Forty consecutive elderly female patients who had a pertrochanteric fracture were randomized to be treated with either fixation with a 135 degrees four-hole sliding hip screw (Group A) or an external fixation device with hydroxyapatite-coated pins (Group B). The inclusion criteria were female gender, an age of at least sixty-five years, an AO/OTA type-A1 or A2 fracture, and a bone mineral density T-score of less than -2.5. There were no differences in patient age, fracture type, bone mineral density, comorbidities, length of hospital stay, or quality of reduction between the two groups. The average intraoperative time (and standard deviation) was 64 +/- 6 minutes in Group A and 34 +/- 5 minutes in Group B (p < 0.005). The average number of units of blood transfused postoperatively was 2.0 +/- 0.1 in Group A and none in Group B (p < 0.0001). Group B had less pain five days postoperatively (p < 0.05). Varus collapse of the fracture at six months averaged 6 degrees +/- 8 degrees in Group A and 2 degrees 1 degrees in Group B (p < 0.002). No pin-track infections occurred in Group B. The average Harris hip score at six months was 62 +/- 19 points in Group A and 63 +/- 17 points in Group B. This study showed that external fixation with hydroxyapatite-coated pins is an effective treatment for this fracture in this patient population. The operative time is brief, the blood loss is minimal, the fixation is adequate, and the reduction is maintained over time.

Application of external fixator mounted on hydroxyapatite-coated pins to treat open fractures of tibia and humerus in the middle aged and old patients

目的 总结应用外固定支架和羟基磷灰石涂层钉治疗开放性中老年胫骨、肱骨骨折的临床经验.方法分析2002年1月～2003年7月55岁以上肱骨和胫骨开放性骨折患者18例.应用单侧外固定支架,固定钉使用螺纹上覆盖有羟基磷灰石涂层的不锈钢钉(Orthofix,Italy),常规使用抗生素链珠.患者均予测定骨密度并服用钙剂.部分患者应用治疗骨质疏松药物.结果17例患者获得超过5个月以上的随访,平均随访8.2个月.16例患者在术后平均18周内(98～159d)达到临床愈合.1例ⅢA型开放性骨折有局部感染和骨不连.无支架、螺钉松动发生.结论羟基磷灰石涂层钉应用于外固定支架治疗中老年开放性胫骨、肱骨骨折,具有稳定性好、康复早的特点,是一种恰当的治疗骨质疏松性骨折的手术方法.有必要对此进行更多病例的前瞻性研究。