Intramedullary Pin Fixation Research Articles

Intramedullary pin fixation in 3D printed canine femur bone model for preoperative surgical planning

Intramedullary pin fixation in 3D printed canine femur bone model for preoperative surgical planning

Stability of fractured end of femur in young dogs affecting the status of the hip joints using intramedullary pinning

In the study 10 dogs were sourced from 2 litters, and were randomly assorted into 3 experimental groups. The intramedullary pinning of the femur of the young dogs were evaluated to know the status of the hip joints. Fractures were created on the femur of the experimental dogs and attempts were made to oppose or align then using the retrograding and normograding techniques. It showed that retrograding techniques with multiple intramedullary pinning provide stability to the corrected fractured limb, and frequent evaluation of the radiographic status of the hip and bones in managing femoral fracture repair by intramedullary pin fixation in young dogs to determine when it is soonest and best to remove the pins.
 Key Words: Intramedullary pins. Femur. Hip joint. dogs. Status.

Outcomes of intramedullary steinmann pin fixation for concurrent fibula fracture in comminuted tibia shaft or distal metaphyseal tibia fractures

Background: Fracture of the tibia shaft accounts for 17% of lower extremity fractures, with concurrent fibula fracture in about 78% of these cases. Intramedullary fixation for fibula fractures can restore fibula alignment and thus facilitate fracture reduction, especially in cases with comminuted shaft or distal metaphyseal tibia fractures. Methods: Patients who had internal fixation of comminuted tibia shaft or distal metaphyseal tibia fracture and a concurrent fibular fracture treated with intramedullary Steinman pin fixation were included in this study. Patients' demographic data and fracture patterns were analyzed retrospectively. Postoperative X-rays were used for fracture union evaluation and alignment analysis. Results: Nine males and one female were included in the present study. Tibia fractures were classified as four OTA42 and as six OTA43, including one type I, two type II, one type IIIA, and three type IIIB open fractures. Intramedullary nail and locking plate were used as definitive fixation in four and six cases, respectively. Complications required additional surgeries including wound debridement for one patient, bone graft for three patients, and revision surgery from a broken plate to an intramedullary nail for one patient. A total of 14 fibula fractures were identified in ten patients due to four segmental fractures. Eight were Weber type C, one was Weber type B, and five were midshaft fractures. The mean duration of fibula fracture healing according to radiographs was 6.9 months. Conclusions: This study suggests that intramedullary Steinmann pin fixation for concurrent fibula fracture is a critical procedure when dealing with comminuted shaft or distal metaphyseal tibia fractures.

The Effects of Adipose Derived Stromal Vascular Fraction and Platelet-Rich Plasma on Bone Healing of a Rat Model With Chronic Kidney Disease.

Chronic kidney disease (CKD) impairs osteoblast/osteoclast balance and damages bone structure with diminished mineralization and results in bone restoration disorders. In this study, we investigate the effects of adipose-derived stromal vascular fraction and platelet-rich plasma (PRP) on bone healing model in rats with CKD. Sprague-Dawley rats were separated into 4 groups. All groups except group I (healthy control) had CKD surgery using 5/6 nephrectomy model. All groups had intramedullary pin fixation after receiving bone fracture using drilling tools. Group II rats were used as control group for CKD. Group III rats received PRP treatment on fracture site. Group IV rats received PRP and stromal vascular fraction treatment on fracture site.Weight loss and blood samples were followed at the time of kidney surgery, third, sixth, and 12th weeks. Bone healing and callus formations were compared, biomechanically, radiologically, histopathologically, and immunohistochemically. Osteoblastic transformation of stem cells was assessed with DiI staining. Negative effects of CKD on bone healing were reduced by increasing mechanical, histological, radiological, and biochemical properties of the bone with stromal vascular fraction and PRP treatments. Although thickness of callus tissue delayed bone healing process, it also enhanced biomechanical features and bone tissue organization. Platelet-rich plasma and adipose-derived stromal vascular fraction treatments were effective for bone healing in animal model, which can be promising for clinical trials.

Comparison between new design interlocking nail with plate fixation and intramedullary pin with external skeletal fixation in long bone fracture in the dogs

New design interlocking nail and plate fixation was used in comminuted femur fracture in an old dog that the results showed primary bone healing and she had been quickly weight baring in fifteenth day after surgery, and could be walk in twenty day after operation. Another case was a young dog that showed transverse fracture of both humerus and one transverse fracture of femur that were repaired by intramedullary pin and external skeletal fixation. The results showed secondary bone healing of these three bone fractures and she could be walk after 2 months of operation. An old dog did not show any complication but a young dog showed pin migration in femur healing. This study revealed that the superior result in bone healing was found in rigid fixation by new design interlocking nail and plate fixation greater than intramedullary pin with external skeletal fixation.

Retrograde Intramedullary Absorbable Pin Fixation for Intraarticular Fracture of the Metacarpal Head

Purpose To review retrospectively the outcome of retrograde intramedullary absorbable pin fixation for intra-articular fractures of the metacarpal head. Methods Nine patients with intra-articular fractures of the metacarpal head were treated surgically with 1.5-mm-diameter unsintered hydroxyapatite particles and a poly- l -lactide pin. There were 2 women and 7 men, mean age 28.9 years. Patients were observed for a mean of 13.1 months after surgery. The metacarpophalangeal joint was exposed through a dorsal skin incision. After reduction of the fracture, 2 unsintered hydroxyapatite particles and poly- l -lactide pins were inserted from the articular surface of the distal bone fragment into the medullary canal of the metacarpal. A volar aluminum orthosis was applied in the intrinsic plus position for a mean of 1.8 weeks (range, 0–4 weeks), and range of motion exercises were started after the orthosis was removed. Results Anatomical reduction and bony union were achieved in all patients. Mean period required to achieve bone union was 4.6 weeks. No patients experienced pain after healing; all resumed normal activities at the time of follow-up, when mean flexion and extension of the metacarpophalangeal joint were 82.8° and –2.2°, respectively. There were no malunions or osteoarthritic changes, no breakage of the pin, aseptic inflammation, or avascular necrosis of the metacarpal head, and no foreign body reactions. Conclusions We performed a retrograde intramedullary absorbable pin fixation for intra-articular fracture of the metacarpal head. Using this method, damage to the articular cartilage and surrounding soft tissue was minimized, range of motion exercise could be started early after surgery, and hardware removal surgery was not necessary. Type of study/level of evidence Therapeutic IV.

Morphine Exacerbates Postfracture Nociceptive Sensitization, Functional Impairment, and Microglial Activation in Mice.

Emerging evidence suggests that opioid use immediately after surgery and trauma may worsen outcomes. In these studies, the authors aimed to determine whether morphine administered for a clinically relevant time period (7 days) in a tibia fracture orthopedic surgery model had adverse effects on postoperative recovery. Mice were given morphine twice daily for 7 days after unilateral tibial fracture and intramedullary pin fixation to model orthopedic surgery and limb trauma. Mechanical allodynia, limb-specific weight bearing, gait changes, memory, and anxiety were measured after injury. In addition, spinal cord gene expression changes as well as glial activation were measured. Finally, the authors assessed the effects of a selective Toll-like receptor 4 antagonist, TAK-242, on nociceptive and functional changes after injury. Tibial fracture caused several weeks of mechanical nociceptive sensitization (F(1, 216) = 573.38, P < 0.001, fracture + vehicle vs. sham + vehicle, n = 10 per group), and this change was exacerbated by the perioperative administration of morphine (F(1, 216) = 71.61, P < 0.001, fracture + morphine vs. fracture + vehicle, n = 10 per group). In additional testing, injured limb weight bearing, gait, and object location memory were worse in morphine-treated fracture mice than in untreated fracture mice. Postfracture expression levels of several genes previously associated with opioid-induced hyperalgesia, including brain-derived neurotrophic factor and prodynorphin, were unchanged, but neuroinflammation involving Toll-like receptor 4 receptor-expressing microglia was observed (6.8 ± 1.5 [mean ± SD] cells per high-power field for fracture + vehicle vs. 12 ± 2.8 fracture + morphine, P < 0.001, n = 8 per /group). Treatment with a Toll-like receptor 4 antagonist TAK242 improved nociceptive sensitization for about 2 weeks in morphine-treated fracture mice (F(1, 198) = 73.36, P < 0.001, fracture + morphine + TAK242 vs. fracture + morphine, n = 10 per group). Morphine treatment beginning at the time of injury impairs nociceptive recovery and other outcomes. Measures preventing glial activation through Toll-like receptor 4 signaling may reduce the adverse consequences of postoperative opioid administration.

Development of the Utrecht Score for clavicle fractures: a short and complete clavicle score with patient-reported and objective measures.

The purpose of this study was to develop a clavicle-specific questionnaire with patient-reported and objective measures. The present study used data of DASH and Constant scores from a previously performed randomized-controlled trial comparing plate and intramedullary pin fixation of clavicle fractures. Exploratory factor analysis was used to identify the most relevant items and the underlying structure of the questionnaires. To optimize the applicability to patients with a clavicle fracture, the selected items were reformulated. If relevant themes were underexposed, an additional question was added. Based on the scree plot of eigenvalues and the parallel analysis, a seven-factor model with good factorability was constructed. Using exploratory factor analysis, 13 patient-reported and 2 objective measurements were identified. The internal consistency of the selected questions was excellent. An additional question was added to cover complaints relating to direct pressure on the clavicle and implants. The Utrecht Score for clavicle fractures is a compact yet complete tool that was developed to assess functional outcome specifically in patients with a clavicle fracture, consisting of patient-reported and objective measures. After external validation, the USC can be used for research purposes or clinical follow-up during rehabilitation in patients with a clavicle fracture.

Meta-analysis of differences in Constant-Murley scores for three mid-shaft clavicular fracture treatments.

There is no consensus on the optimal treatment for mid-shaft clavicular fracture. We conducted a meta-analysis to compare the effectiveness of non-operative treatment, plate fixation, and intramedullary pin fixation in terms of the Constant-Murley Score (CMS) for treatment of mid-shaft clavicular fracture. Comprehensive search of the Embase, Cochrane Library and PubMed was conducted to retrieve relevant randomized controlled trials (RCTs). A random-effect network meta-analysis was conducted within a Bayesian framework using Markov Chain Monte Carlo (MCMC) in OpenBUGS 3.2.2. Differences in CMS among the three treatments analyzed were evaluated with weighted mean difference (WMD) and surface under the cumulative ranking curves (SUCRA). Eleven studies met our inclusion criteria and were included in our network meta-analysis. Our results revealed that in terms of CMS followed-up for six months, the efficacies of plate fixation and intramedullary pin fixation were higher than non-operative treatment (plate fixation: WMD = 4.70, 95% CI = 1.21 ∼ 7.83; intramedullary pin fixation: WMD = 6.71, 95% CI = 3.20 ∼ 10.39), and intramedullary pin fixation had better efficacy than plate fixation, had better efficacy. However, no differences were found between the efficacies of the three treatments in pairwise comparisons with respect to CMS followed-up for six weeks, three months, 12 months and 24 months. In addition, the cluster analysis showed that intramedullary pin fixation had the best efficacy for patients with mid-shaft CF, followed by plate fixation and non-operative treatment. These analyses suggest intramedullary pin fixation may be the optimal therapeutic approach for mid-shaft clavicular fracture patients.

Effect of Pentoxifylline Administration on an Experimental Rat Model of Femur Fracture Healing With Intramedullary Fixation.

Background:Globally, musculoskeletal injuries comprise a major public health problem that contributes to a large burden of disability and suffering. Pentoxifylline (PTX) has been originally used as a hemorheologic drug to treat intermittent claudication. Previous test tube and in vivo studies reported the beneficial effects of PTX on bony tissue.Objectives:This study aims to evaluate the effects of different dosages of PTX on biomechanical properties that occur during the late phase of the fracture healing process following a complete femoral osteotomy in a rat model. We applied intramedullary pin fixation as the treatment of choice.Materials and Methods:This experimental study was conducted at the Shahid Beheshti University of Medical Sciences, Tehran, Iran. We used the simple random technique to divide 35 female rats into five groups. Group 1 received intraperitoneal (i.p.) PTX (50 mg/kg, once daily) injections, starting 15 days before surgery, and group 2, group 3, and group 4 received 50 mg/kg, 100 mg/kg, and 200 mg/kg i.p. PTX injections, respectively, once daily after surgery. All animals across groups received treatment for six weeks (until sacrificed). Complete surgical transverse osteotomy was performed in the right femur of all rats. At six weeks after surgery, the femurs were subjected to a three-point bending test.Results:Daily administration of 50 mg/kg PTX (groups 1 and 2) decreased the high stress load in repairing osteotomized femurs when compared with the control group. The highest dose of PTX (200 mg/kg) significantly increased the high stress load when compared with the control group (P = 0.030), group 1 (P = 0.023), group 2 (P = 0.008), and group 3 (P = 0.010), per the LSD findings.Conclusions:Treatment with 200 mg/kg PTX accelerated fracture healing when compared with the control group.

Total Wrist Fusion Using an Intramedullary Rod Technique With Proximal Row Carpectomy.

Intramedullary pin fixation is a common total wrist fusion technique, particularly for patients with rheumatoid arthritis. However, appropriate alignment of the proximal carpal row on the carpus can be challenging. Inflammatory arthropathy may also degrade the proximal carpal bones to chondral shells, retention of which may promote failure of fusion. We describe an intramedullary rod technique for total wrist fusion that incorporates a proximal row carpectomy.

Pediatric monteggia fractures: a multicenter examination of treatment strategy and early clinical and radiographic results.

Monteggia fractures remain challenging pediatric injuries because of difficulties in diagnosis, propensity for instability, and complexity of late reconstruction. The objective of this investigation was to assess the efficacy of the following treatment strategy based upon ulnar fracture pattern: closed reduction (CR) for plastic/greenstick fractures, intramedullary (IM) pin fixation for transverse/short oblique fractures, and open reduction and internal fixation for long oblique/comminuted fractures. A total of 112 acute Monteggia fracture patients were retrospectively analyzed at two level 1 pediatric trauma centers from 2000 to 2011. Mean age was 6.9±2.9 years (range, 0.6 to 16.7 y); 54% were male. Mean clinical follow-up was 19.8 weeks. Fracture patterns were classified and patients were separated into 3 groups: treatment according to the strategy versus more rigorous versus less rigorous intervention. The Fisher exact test was used to compare the rates of failure between the groups. "Failure" was defined as failure to obtain and maintain an anatomic reduction of the radial head and/or loss of ulnar reduction during follow-up. None of the 57 patients treated according to the strategy experienced failure, nor did any of the 23 patients treated more rigorously. In contrast, 6 of 32 patients (19%) who were treated less rigorously compared with the recommended strategy demonstrated recurrent radiocapitellar instability (n=3), loss of ulnar fracture reduction requiring revision surgery (n=2), or both events together (n=1) (P<0.001). Specifically, all treatment failures occurred in complete fractures treated nonoperatively-there were 6/18 failures (33% failure rate) of complete fractures treated nonoperatively compared with 0/52 failures of complete fractures treated operatively (P<0.001). Other complications were similarly distributed between the treatment groups and consisted of 1 ulnar nonunion, 2 compartment syndromes, and 3 transient nerve palsies/neuropraxias. Comminuted fractures required open reduction of the radiocapitellar joint more than other fracture types (P<0.001). In this pediatric Monteggia series, recurrent instability only occurred in patients who were not treated according to the ulnar-based strategy. Complete ulnar fracture patterns are at risk of failure without initial operative treatment. Level III, therapeutic.

Analysis of Contoured Anatomic Plate Fixation versus Intramedullary Rod Fixation for Acute Midshaft Clavicle Fractures

The recent trend has been toward surgical fixation of displaced clavicle fractures. Several fixation techniques have been reported yet it is unclear which is preferable. We retrospectively reviewed one hundred one consecutive patients with acute midshaft clavicle fractures treated operatively at a level-1 trauma center. Thirty-four patients underwent intramedullary pin fixation and 67 had anatomic plate fixation. The outcomes we assessed were operative time, complications, infection, implant failure, fracture union, range of motion, and reoperation rate. There were 92 males and 9 females with an average age of 30 years (range: 14–68 years). All patients were followed to healing with an average followup of 20 months (range: 15–32 months). While fracture union by six months (P=0.8729) and range of motion at three months (P=0.6139) were similar, the overall healing time for pin fixation was shorter (P=0.0380). The pin group had more infections (P=0.0335) and implant failures (P=0.0245) than the plate group. Intramedullary pin fixation may have improved early results, but there was no long term difference in overall rate of union and achievement of full shoulder motion. The higher rate of implant failure with pin fixation may indicate that not all fracture patterns are amenable to fixation using this device.

Comparison of Complication Rates of Intramedullary Pin Fixation Versus Plating of Midshaft Clavicle Fractures in an Active Duty Military Population

Military service members have increased requirements of shoulder weight bearing to perform duties. Operative intervention has increased for treatment of displaced middle one-third clavicle fractures. Complications of operatively treated clavicle fixation have not been extensively studied. A retrospective, longitudinal cohort chart evaluation was conducted of all active duty members undergoing fixation of middle one-third clavicle fractures, for complications between intramedullary pin fixation and plate constructs. This review found 62 patients meeting inclusion criteria. Thirty-three patients underwent intramedullary pin fixation with Hagie pins and 31 patients underwent precontoured superior clavicle plate fixation of their middle one-third clavicle fractures. Complications included wound infection, skin and/or soft tissue irritation, and need for unplanned hardware removal. The overall complication rate was 31% in the plate fixation group versus 9% in the intramedullary pin group (p = .024). All patients achieved fracture union with return to duty; however, increased overall complications were seen in the plate fixation group.

Systematic review of the complications of plate fixation of clavicle fractures

BackgroundThe number of displaced midshaft clavicle fractures treated surgically is increasing and plate fixation is often the treatment modality of choice. The study quality and scientific levels of evidence at which possible complications of this treatment are presented vary greatly in literature.PurposesThe purpose of this systematic review is to assess the prevalence of complications concerning plate fixation of dislocated midshaft clavicle fractures.MethodsA computer-based search was carried out using EMBASE and PUBMED/MEDLINE. Studies included for review reported complications after plate fixation alone or in comparison to either treatment with intramedullary pin fixation and/or nonoperative treatment. Two quality assessment tools were used to assess the methodological quality of the studies. Included studies were ranked according to their levels of evidence.ResultsAfter study selection and reading of the full texts, 11 studies were eligible for final quality assessment. Nonunion and malunion rates were less than 10% in all analysed studies but one. The vast majority of complications seem to be implant related, with irritation or failure of the plate being consistently reported on in almost every study, on average ranging from 9 to 64%.ConclusionThe quantity of relevant high evidence studies is low. With low nonunion and malunion rates, plate fixation can be a safe treatment option for acute dislocated midshaft clavicle fractures, but complications related to the implant material requiring a second operation are frequent. Future prospective trials are needed to analyse the influence of various plate types and plate position on implant-related complications.

Midshaft clavicular fractures: comparison of intramedullary pin and plate fixation

Intramedullary pin and plate fixation for midshaft clavicular fractures both have their proponents, but little comparative data are available. We performed a retrospective comparison of these 2 techniques. A retrospective review was performed on 40 consecutive patients with closed, simple, or wedge-type midshaft clavicular fractures that were identified from a prospectively collected orthopedic trauma database. Eight patients were excluded due to incomplete follow-up. Intramedullary pins were used in 18 patients and plates in 14; of these, 7 plates were placed superiorly, 6 anteriorly, and 1 inferiorly. Treatment method was determined by preference of the treating surgeon. Among the patients treated with intramedullary pin fixation, all 18 fractures healed, and each underwent a planned procedure for pin removal. Complications included 1 intraoperative pin breakage, 1 superficial wound infection, 2 prominent symptomatic pins, and 1 transient brachial plexopathy. Among the patients treated with plating, delayed union occurred in 1, and refractures occurred in 2 (1 required a second procedure). Three patients underwent plate removal for symptomatic hardware. No patients in either group had significant loss of shoulder motion. Intramedullary pin fixation for acute, simple, or wedge-type midshaft clavicular fractures provides a safe and predictable alternative to plate and screw fixation.

Foraminal index on the dog femora

Summary: Damages of the main nutrient artery during the fractures may lead to poor repair or bone infarcts. Therefore, knowledge about the localization and number of nutrient foramina of bones is important in some surgical procedures such as bone implants, fracture repair, bone grafts. Foraminal index is calculated as dividing the distance between proximal end of the bone and nutrient foramen to the total bone length. One hundred and twelve femora of the 56 mature dogs were used in this study. The general morphometric parameters of femur; the total length, the cranio-caudal and medio-lateral diameters of mid-femur were taken. The numbers of the primary and secondary nutrient foramina were determined and the foraminal index was calculated. One foramen nutricium was determined at the 88 bones while two foramen at the 24 bones. The mean foraminal index was 36.4%, between ranges of 31.8% - 55.1% in dog femora. Statistical difference of foraminal index was not determined between male and female dog femora. These data may be valuable for surgeons in cases of total hip arthroplasty, intramedullary pin, and external fixation and also on evaluating period of fracture repair after surgery.

Treatment of unstable distal clavicle fractures with Knowles pin

Unstable distal clavicle fractures often need surgical treatment. This report describes a new intramedullary extra-articular Knowles pin fixation method to treat these unstable fractures. Twelve patients with unstable distal clavicle fractures (Neer type II) had surgery with intramedullary extra-articular Knowles pin fixation. We retrospectively reviewed clinical results for pain, shoulder function, and range of motion, as well as radiographic results, for this institutional review board-approved study. Each patient's operated arm was in a sling for 4 weeks postoperatively. The University of California, Los Angeles shoulder rating scale score was used to evaluate shoulder function. All patients showed radiographically confirmed bony union. The mean period required for healing was 11.5 weeks, and patients were followed up for 6 to 24 months (mean, 15.2 months), during which University of California, Los Angeles scores (mean, 33.9) indicated good clinical results. Three patients had the complication of proximal or distal skin irritation caused by the thread and hub of the Knowles pin. The Knowles pin fixation method is useful for treating unstable distal clavicle fractures. However, sufficient familiarity with the technique and careful preoperative planning to determine the appropriate length of the pin are necessary to prevent complications and to effect a high union rate.

Biomechanical Comparison of Contemporary Clavicle Fixation Devices

Because recent studies have shown that malunited or nonunited clavicle fractures treated nonsurgically have poor outcomes, early fixation of certain clavicle shaft fractures using contemporary implants has become more common. Little is known about the physiologic loading of these implants. This study was designed to observe the biomechanical behavior and strength of implants used for fixation of the clavicle shaft. We used synthetic clavicle bones that were produced in 2 pieces to replicate the conditions of a transverse fracture. Ten specimens per group were tested using 3 clavicle fixation constructs: precontoured clavicle plates with unicortical locking, precontoured clavicle plates with bicortical nonlocking screws, and intramedullary Rockwood clavicle pins. Two loading conditions were used: cantilever bending and 3-point bending. For cantilever bending, both plate groups failed by fracture at the most medial screw hole. The pin group was unable to resist the small torque associated with off-axis loading. The pin group failed at a lower maximum load, which occurred with a greater maximum displacement. The pin group was also less stiff than the plate group. In the 3-point bending test, the pin group was significantly more flexible and achieved higher failure loads than the plate groups. There were no significant differences between the unicortical and bicortical screws for any of the measured variables with either loading condition. Both locking and nonlocking constructs appear to provide similar rigid fixation under the tested mechanical conditions. The intramedullary pin can provide high resistance to failure loads in situations when rigidity and rotational stiffness are not required. Intramedullary pin fixation appears to be inadequate where rotational stiffness is required.

Ergebnisse nach percutaner intramedullärer Bohrdrahtspickung bei distalen Radiusfrakturen

42 distal radius fractures have been submitted to further examination after percutaneous intramedullary pin fixation. The outcome were 95.3% of very good to good anatomic results and 90.5% of satisfying functional results. This showed the close link between the radiological-anatomical and functional results. The success of the treatment was very acceptable, although the Morbus Sudeck as the major complication--with 7.2%--was still relatively frequently observed. It could be seen that particularly fractures at the risk of dislocation with smash zone constituted an indication for the percutaneous intramedullary pin fixation, that is to say all fractures for which a retention is primarily difficult. It constitutes a supplement, as well as an extension to the therapy of the distal radius fractures.