Pin Loosening Research Articles

Unilateral external fixator and its biomechanical effects in treating different types of femoral fracture: A finite element study with experimental validated model

Previous works had successfully demonstrated the clinical effectiveness of unilateral external fixator in treating various types of fracture, ranging from the simple type, such as oblique and transverse fractures, to complex fractures. However, literature that investigated its biomechanical analyses to further justify its efficacy is limited. Therefore, this paper aimed to analyse the stability of unilateral external fixator for treating different types of fracture, including the simple oblique, AO32C3 comminuted, and 20 mm gap transverse fracture. These fractures were reconstructed at the distal diaphysis of the femoral bone and computationally analysed through the finite element method under the stance phase condition. Findings showed a decrease in the fixation stiffness in large gap fracture (645.2 Nmm-1 for oblique and comminuted, while 23.4 Nmm-1 for the gap fracture), which resulted in higher displacement, IFM and stress distribution at the pin bone interface. These unfavourable conditions could consequently increase the risk of delayed union, pin loosening and infection, as well as implant failure. Nevertheless, the stress observed on the fracture surfaces was relatively low and in controlled amount, indicating that bone unity is still allowable in all models. Briefly, the unilateral fixation may provide desirable results in smaller fracture gap, but its usage in larger gap fracture might be alarming. These findings could serve as a guide and insight for surgeons and researchers, especially on the biomechanical stability of fixation in different fracture types and how will it affect bone unity.

Single Bone Intramedullary Fixation of the Radius in Pediatric Both Bone Forearm Fractures Using Straight Stainless Steel Kirschner Wire: A Cross-sectional Study on Radiological and Clinical Feature.

We aimed to report radiological and clinical features of single bone intramedullary fixation of the radius in pediatric both bone forearm fractures using straight stainless steel Kirschner (K) wire. Fifty-eight children (42 boys and 16 girls) referred to our hospital with both bone diaphyseal forearm fractures were operated on by using the single bone rigid K-wire intramedullary fixation and mini-open technique. The mean follow-up time was 8.9 months (6-12). The mean age of the patients was 7.4 years (4-12). More than 2/3 of the fractures were in the right hand. Around 63% of the fractures were in the middle third, 28% in the distal third, and 9% in the proximal third. Moreover, 12% were open type I Gustilo-Anderson fractures. The mean time from injury to surgery was two days (1-4), and the mean length of hospital stay was 2.8 days (2-5). The mean duration of surgery was 24.7 minutes (18-38), and the mean follow-up time was 8.9 months (6-12). All fractures united within 4-16 weeks (mean: 7.62). The cast and implant were removed simultaneously as the radiographic fracture union. There was no serious complication. Superficial infection of the pin track and loosening of the pin occurred in three cases (5%), all controlled by antibiotics and timely removal of the pins. Mild restriction of elbow extension (less than 20 degrees) was observed in three cases, which returned to normal at the last follow-up. Limitation of dorsiflexion of the wrist by more than 20° occurred in two patients (35° and 45°), which reverted to 25° and 25°, respectively, at the last follow-up. In both bone forearm fractures in children, open reduction and internal fixation of only the radius with a stainless steel straight Kirschner wire could be a promising method with good results. This retrograde technique of intramedullary fixation is a simple and cost-effective method with minimal complications and acceptable outcomes in children aged 4-12 years.

Comparative analysis of external locking plate and combined frame external fixator for open distal tibial fractures: a comprehensive assessment of clinical outcomes and financial implications

BackgroundOpen distal tibial fractures pose significant challenges regarding treatment options and patient outcomes. This retrospective single-centre study aimed to compare the stability, clinical outcomes, complications, and financial implications of two surgical interventions, namely the external locking plate and the combined frame external fixator, to manage open distal tibial fractures.MethodsForty-four patients with distal open tibial (metaphyseal extraarticular) fractures treated between 2020 and 2022 were selected and formed into two main groups, Group A and Group B. Group A (19 patients) are patients that underwent treatment using the external locking plate technique, while Group B (25 patients) received the combined frame external fixator approach. Age, gender, inpatient stay, re-operation rates, complications, functional recovery (measured by the Johner-Wrush score), pain ratings (measured by the Visual Analogue Scale [VAS]), and cost analyses were evaluated for each group. Statistical analyses using SPSS were conducted to compare the outcomes between the two groups.ResultsThe research found significant variations in clinical outcomes, complications, and cost consequences between Group A and Group B. Group A had fewer hospitalisation periods (23.687.74) than Group B (33.5619.47). Re-operation rates were also considerably lower in Group A (26.3%) than in Group B (48%), owing to a greater prevalence of pin-tract infections and subsequent pin loosening in the combination frame external fixator group. The estimated cost of both techniques was recorded and analysed with the locking average of 26,619.69 ± 9,602.352 and the combined frame average of 39,095.64 ± 20,070.077.ConclusionThis study suggests that although the two approaches effectively manage open distal tibia fractures, the locking compression plate approach (Group A) has an advantage in treating open distal tibia fractures. Shorter hospitalisation times, reduced re-operation rates, and fewer complications will benefit patients, healthcare systems, and budget allocation. Group A's functional recovery results demonstrate the locking plate technique's ability to improve recovery and patient quality of life. According to the cost analysis, the locking plate technique's economic viability and cost-effectiveness may optimise healthcare resources for open distal tibia fractures. These findings might improve patient outcomes and inform evidence-based orthopaedic surgery.

Ilizarov method and its combined methods in the treatment of long bone defects of the lower extremity: systematic review and meta-analysis

BackgroundIlizarov method has become one of primary methods for treating bone defects. Currently, there is growing trend in the application of modified Ilizarov methods (e.g., applying unilateral external fixators or with flap tissue) and its combined methods (e.g., Ilizarov method with antibiotic spacer or internal fixation) to manage bone defects. However, there is a lack of studies with systematical evaluation of the clinical effects of these evolving methods. This study aimed to conduct a systematic review and meta-analysis for overall evaluating the clinical effects on long bone defects of lower extremity in Ilizarov methods and its combined methods.MethodsStudies were identified in three electronic databases (Pubmed, Embase and Cochrane Library) from the earliest indexing year through November 01, 2022, and relevant data were extracted subsequently. The total number of participants, number of participants with bone unions, bone result or functional result, and related complications including pin infection, pin loosening, pain, refracture, limb discrepancy, malalignment, joint stiffness, recurrent infection, and amputation were extracted in this study. Then, union rate (defined as the proportion of patients who achieved bone unions) and specific complication incidence rate (defined as the proportion of patients who experienced specific complication) were pooled estimated respectively. Relative risk (RR) was used for comparing the clinical effects among various Ilizarov technique.ResultsSixty-eight case series studies, 29 comparative studies, and 3 randomized clinical trials were finally included. The union rate of Ilizarov methods was 99.29% (95% CI: 98.67% ~ 99.86%) in tibial defects and 98.81% (95% CI: 98.81% ~ 100.00%) in femoral defects. The union rate of Ilizarov method with antibiotic spacer and intramedullary nail in tibial defects was 99.58% (95% CI: 98.05% ~ 100.00%) and 95.02% (95% CI: 87.28% ~ 100.00%), respectively. Compared to the Ilizarov methods, the union rate of the Ilizarov method with antibiotic spacer in tibial defects increased slightly (RR = 1.02, 95% CI: 1.01 ~ 1.04). Meanwhile, compared to Ilizarov methods, we found lower excellent rate in bone result in Ilizarov method with antibiotic spacer, with the moderate to high heterogeneity. Compared to the Ilizarov method, lower rate of pin infection, higher rate of recurrent infection and amputation were observed in Ilizarov method with intramedullary nail, however, the findings about the comparison of pin infection and recurrent infection between the two groups were presented with high degree of statistical heterogeneity.ConclusionOur study confirmed the reliable treatment of Ilizarov methods and its combined technique on long bone defects, and founded there were significant differences on some complications rate between Ilizarov methods and its combined technique. However, the findings need to be confirmed by further studies.

EVALUATION OF THE SELF-DRILLING, SELF-TAPPING SCHANZ PIN THREAD PATTERNS ON THE NEAR CORTEX WHEN INSERTED IN BONE WITHOUT PRE-DRILLING

The external fixator is an invaluable device when treating acute complex trauma and in limb reconstruction. It is therefore important to ensure its efficient and safe application to avoid complications. A lot of research has been done to evaluate the factors around external fixator stability, pin site infections and more is still being done to understand pin loosening. The purpose of this study was to evaluate other factors that may contribute in external fixator pin loosening. The aim was to evaluate if the different Schanz pin insertion techniques contribute to pin loosening.Two tibia diaphyses from two cadavers were each divided into three sections. Three different drilling techniques were repeated in each of the sections. A total of 36 Schanz pins were inserted and a section cut out of the bone in front of the pins was done allowing visual inspection of the pin hole for features of thread stripping. These features were predefined as thread pattern disruption, smoothening and shallow imprint on the cortex.Evidence of pin thread stripping was seen in all of the pin insertion techniques. The first method where the hole was pre-drilled and pin inserted with the drill showed 100% thread stripping. The second method of pre-drilling and hand insertion showed the least amount with 16.7% of pin stripping noted and 66.7% pin thread stripping was observed when inserting the pin with power without pre-drilling the pilot hole using the third method.Different pin insertion techniques result in varying amounts of pin thread stripping. The most amount of thread stripping occurs when a Schanz pin is inserted with power after pre-drilling. This finding, although not measured scientifically, supports the current recommendation of pre-drilling and manual insertion of the pin. In future, more scientific measurement are necessary to quantify these findings and assess their clinical significance.

Intra-operative Safety of an Autonomous Robotic System for Total Knee Replacement: A Review of 500 Cases in India.

Manual total knee arthroplasty (TKA) has been documented several times for their safety and complications data. In contrast, there is a limited evidence-based analysis for safety and complications of autonomous robotic-assisted (RA)-TKA. This study aimed to evaluate the safety features and intra-operative surgical complications associated with the use of Cuvis Joint™ autonomous robotic system for TKA. The study included 500 consecutive patients who underwent TKA using the Cuvis Joint™ autonomous robotic system from November 2020 to November 2021. All surgeries were performed by a senior surgeon. Patients in whom the surgery was abandoned midway due to technical errors, were excluded from the analysis. In case of unilateral abandonment of the robotic arm during a bilateral RA-TKA, data of the side on which the surgery was completed with robotic assistance was recorded. There was no incidence of neurological injury, vascular injury, extensor mechanism disruption, or medial collateral ligament injury. There was one case of superficial abrasion of the patellar tendon; however, it did not require any intervention. There were no cases of midway abandonment due to threatened soft tissue injury. There was no intra-operative pin loosening or stress-related fractures at the pin sites. There was one case of Steinmann pin breakage and another case of drill bit breakage, which were removed without any damage to the bone. The Cuvis Joint™ autonomous robotic system for TKA is safe with no significant intra-operative complications.

The Influence of Sagittal Pin Angulation on the Stiffness and Pull-Out Strength of a Monolateral Fixator Construct.

Monolateral pin-to-bar-clamp fixators are commonly used to stabilize acute extremity injuries. Certain rules regarding frame geometry have been established that affect construct stability. The influence of sagittal pin angulation on construct stiffness and strength has not been investigated. The purpose of this biomechanical study was to demonstrate the effect of a pin angulation in the monolateral fixator using a composite cylinder model. Three groups of composite cylinder models with a fracture gap were loaded with different mounting variants of monolateral pin-to-bar-clamp fixators. In the first group, the pins were set parallel to each other and perpendicular to the specimen. In the second group, both pins were set convergent each in an angle of 15° to the specimen. In the third group, the pins were set each 15° divergent. The strength of the constructions was tested using a mechanical testing machine. This was followed by a cyclic loading test to produce pin loosening. A pull-out test was then performed to evaluate the strength of each construct at the pin-bone interface. Initial stiffness analyses showed that the converging configuration was the stiffest, while the diverging configuration was the least stiff. The parallel mounting showed an intermediate stiffness. There was a significantly higher resistance to pull-out force in the diverging pin configuration compared to the converging pin configuration. There was no significant difference in the pull-out strength of the parallel pins compared to the angled pin pairs. Convergent mounting of pin pairs increases the stiffness of a monolateral fixator, whereas a divergent mounting weakens it. Regarding the strength of the pin-bone interface, the divergent pin configuration appears to provide greater resistance to pull-out force than the convergent one. The results of this pilot study should be important for the doctrine of fixator mounting as well as for fixator component design.

DRY GAUZE AND IODINE TULLE DRESSINGS FOR THE PREVENTION OF INFECTION IN PATIENTS WITH A LOWER LIMB EXTERNAL FIXATOR: A RETROSPECTIVE OBSERVATIONAL STUDY

DRY GAUZE AND IODINE TULLE DRESSINGS FOR THE PREVENTION OF INFECTION IN PATIENTS WITH A LOWER LIMB EXTERNAL FIXATOR: A RETROSPECTIVE OBSERVATIONAL STUDY

Does Augmented Reality-based Portable Navigation Improve the Accuracy of Cup Placement in THA Compared With Accelerometer-based Portable Navigation? A Randomized Controlled Trial.

Previous studies reported good outcomes of acetabular cup placement using portable navigation systems during THA. However, we are aware of no prospective studies comparing inexpensive portable navigation systems using augmented reality (AR) technology with accelerometer-based portable navigation systems in THA. (1) Is the placement accuracy of the acetabular cup using the AR-based portable navigation system superior to that of an accelerometer-based portable navigation system? (2) Do the frequencies of surgical complications differ between the two groups? We conducted a prospective, two-arm, parallel-group, randomized controlled trial involving patients scheduled for unilateral THA. Between August and December 2021, we treated 148 patients who had a diagnosis of osteoarthritis, idiopathic osteonecrosis, rheumatoid arthritis, or femoral neck fracture and were scheduled to undergo unilateral primary THA. Of these patients, 100% (148) were eligible, 90% (133) were approached for inclusion in the study, and 85% (126) were finally randomized into either the AR group (62 patients) or the accelerometer group (64 patients). An intention-to-treat analysis was performed, and there was no crossover between groups and no dropouts; all patients in both groups were included in the analysis. There were no differences in any key covariates, including age, sex, and BMI, between the two groups. All THAs were performed via the modified Watson-Jones approach with the patient in the lateral decubitus position. The primary outcome was the absolute difference between the cup placement angle displayed on the screen of the navigation system and that measured on postoperative radiographs. The secondary outcome was intraoperative or postoperative complications recorded during the study period for the two portable navigation systems. There were no differences between the AR and accelerometer groups in terms of the mean absolute difference in radiographic inclination angle (3° ± 2° versus 3° ± 2° [95% CI -1.2° to 0.3°]; p = 0.22). The mean absolute difference in radiographic anteversion angle displayed on the navigation screen during surgery compared with that measured on postoperative radiographs was smaller in the AR group than that in the accelerometer group (2° ± 2° versus 5° ± 4° [95% CI -4.2° to -2.0°]; p < 0.001). There were few complications in either group. In the AR group, there was one patient each with a surgical site infection, intraoperative fracture, distal deep vein thrombosis, and intraoperative pin loosening; in the accelerometer group, there was one patient each with an intraoperative fracture and intraoperative loosening of pins. Although the AR-based portable navigation system demonstrated slight improvements in radiographic anteversion of cup placement compared with the accelerometer-based portable navigation system in THA, whether those small differences will prove clinically important is unknown. Until or unless future studies demonstrate clinical advantages that patients can perceive that are associated with such small radiographic differences, because of the costs and the unquantified risks associated with novel devices, we recommend against the widespread use of these systems in clinical practice. Level I, therapeutic study.

MANAGEMENT OF METACARPAL FRACTURE TREATED WITH CLOSED INTRAMEDULLARY PRE-BENT K-WIRE INSERTION USING BOUQUET TECHNIQUE

Background: Metacarpal fractures are among the most common fractures majority of which are treated conservatively. There are numerous indications and techniques for operative xation. The purpose of this research is to study the management of metacarpal fracture treated with intramedullary pre-bent K-wires using Bouquet technique. 100 patients aged between 18-60yea Materials and Method: rs, with 100 closed metacarpal fractures involving shaft and neck region, which were ≤2weeks old, were included in this study. Radiograph of the involved hand anteroposterior (AP) and oblique views were obtained. Postoperative immobilization and rehabilitation regimen were followed for all the patients. Outcome assessment was done using Visual analogue score (VAS), Disabilities of the arm, shoulder and hand (DASH) score, Total active movement (TAM) and grip strength. Radiographs were taken at regular intervals. Descriptive statistical analysis was done using MS Excel 2019. Result and Observations: Out of 100 patients, 73 were male, with overall mean age of 31.76±10.46 years. Right side was affected in 63 patients, however the dominant side was involved in 73 cases. Metacarpal shaft was involved more often (77/100 cases). Most common cause was sports injury. At nal follow-up, mean post-op VAS was 0.33±0.54, mean post-op DASH score was 2.44±3.91, mean TAM score was 232.33±22.38º and the mean grip strength was 94.37±6.53%. Pin tract infection was seen in 13 patients; pin loosening in 10 patients and partial stiffness in 7 patients. Conclusion: The proposed technique is simple, minimally invasive, less time consuming and provides satisfactory stabilization for early union. This xation technique also showed good functional and radiographic outcome with few complications

A prospective study of functional evaluation of distal radius fracture by external fixator using the principle of ligamentotaxis

Background: Preservation of the articular congruity is the principal prerequisite for successful recovery following distal radius fractures. The best method of obtaining and maintaining an accurate restoration of articular anatomy however, remains a topic of considerable controversy. External fixation as a method of treatment for distal end of radius fracture has more than 60 years of documented clinical experience. The main aim of the study is to evaluate the results obtained by treatment of distal end radius fractures by external fixation using the principle of ligamentotaxis. Methods: In a prospective controlled study, 30 cases of distal end radius fractures with intra articular extension were treated with uniplanar bridging type of external fixation using the principle of ligamentotaxis. Mean age of the patients was 40.2 years, external fixator was applied for a mean duration of 6 weeks. Results: In this study there were 8 patients with excellent results comprising 27%, 14 patients with good results comprising 47%, 7 patients with fair results comprising 23%, 1 patient with poor results comprising 3%. Conclusions: In a prospective investigation, static external fixators were applied to 30 intra-articular fractures of the distal end of the radius. Fixator was kept up for a total of six weeks. The results were 8 excellent, 14 good, 7 fair, and 1 poor. Only one complication, pin loosening (10%), occurred. This series concludes that ligamentotaxis by external fixation consistently produces a good result in the management of intra-articular distal end of radius fractures in younger age groups (50 years).

Multifocal percutaneous pin fixation of talar neck fractures: An alternative to ORIF in the polytraumatized patient

PurposeUnique anatomy, precise articulations, fragile vascularity, and the demand for anatomic reduction make talar neck fractures challenging to treat, whether with screws and/or plates. Multifocal percutaneous pin fixation (MPPF) offers an alternative to ORIF, particularly in the polytraumatized patient. MethodsUnless an open lateral wound or medial malleolus fracture was present, a standard anteromedial approach was performed. K-wires placed within the talar head were used as joysticks to facilitate and finalize reduction. At least 3 wires were placed medially and 2 laterally across the talar neck. Incisions were closed in 2 layers, and either a well-padded short leg splint or adjunctive ankle-spanning external fixation was utilized. Patients remained non-weightbearing until K-wire removal in the office at approximately 6–8 weeks postoperatively. ResultsMPPF was performed in 7 patients, the majority of whom were female (6 of 7). The average patient age at the time of injury was 30.3 years (range 17–51 years). The median time of final follow up was 27 months. Comminution was present in all patients. Avascular necrosis (AVN) developed in 3 patients and non-union occurred in 2 patients. All patients developed subtalar posttraumatic arthritis, and 6 additionally developed tibiotalar arthritis. No patients underwent talectomy or osteotomy, and there were no superficial pin site infections or loosening of pins prior to scheduled removal. ConclusionsObtaining and maintaining an adequate reduction is possible with minimal soft tissue compromise through MPPF. Despite the complexity of the series, outcomes utilizing MPPF are comparable to those reported in the literature.

A Comparative Study of Treatment With External Fixator Versus Antibiotic Coated Intramedullary Nail in Infected Non-union Long Bones.

Infected non-union of bones shows problems in providing stability and controlling the infection. The treatment comprises debridement with or without the use of antibiotic cement and achieving stability by either external or internal fixation with or without bone grafting. The use of antibiotic-impregnated cement-coated intramedullary nailing gives stability and treats the infection, thereby permitting early mobilization. External fixation is a definitive mode of fracture stabilization indicated in cases of infected non-unions of the humerus, tibia, and juxta-articular bone. The present study was conducted to compare the results of management of infected non-union long bones treated with an external fixator (Ilizarov and Limb Reconstruction System (LRS)) and vancomycin-coated intramedullary nail. The presentprospective study was conducted on 40 study subjects aged >18 years, and were randomly divided using the alternative method into two groups. Group A: 20 Patients were treated with antibiotic-coated intramedullary interlocking nail (ACIIN). Group B: 20 patients were treated with the external fixator (LRS/Ilizarov). All patients were then evaluated post-operatively using laboratory investigations, and for any sign of inflammation or infection. Results were evaluated usingassociation for the study and application of methods of Ilizarov (ASAMI) scoring system. Data were analyzed using the Statistical Package for Social Sciences (SPSS) version 20 (IBM Corp., Armonk, NY, USA). It was observed that 80.0% of patients in Group A, and 70% of subjects in Group Bshowed bony union, revealing a statistically significant (p-value<0.05) difference. Infection control, limb length discrepancy, and deformity were also assessed in both groups. Bone and functional outcomes were assessed using the ASAMI score in both groups. In LRS/Ilizarov, it was observed that 55% of subjects had no infection, 15% showed loosening, and 30% had an infection. The ACIIN should not be used for bone defects more than 4 cm as it does not achieve stability and for these cases, procedures like external fixators (Ilizarov and LRS) should be used. Antibiotic-coated nail eliminated the complications of the external fixators like pin loosening, and pin infections and was technically less demanding. In our study, stiffness of adjacent joints was more in external fixators (LRS/Ilizarov) than ACIIN.

Outcomes of a Mini External Fixator System for the Treatment of Unstable Periphyseal Hand Fractures.

Background: Most unstable hand fractures in children are treated by closed methods. If osteosynthesis is required, Kirschner (K)-wires are commonly used, though they carry a risk of injury to the physis. We have been using a mini external fixator system (MEFS) for the treatment of unstable periphyseal fractures of the hand. The aim of this study is to describe the application and report the outcomes of MEFS for the treatment of periphyseal fractures of the hand. Methods: We retrospectively reviewed all the patients with periphyseal fracture of the hand treated with MEFS from March 2010 to December 2019. Data with regard to age, sex, hand dominance, digit and bone injured, mechanism of injury, medical records and related radiographs were collected. Salter-Harris classification was used to classify epiphyseal fractures and the Al-Qattan classification for categorising neck fractures. Range of motion and residual deformity of the affected fingers were evaluated during follow-up and at 3 months postoperatively. Results: Fourteen periphyseal unstable fractures were treated using closed reduction and MEFS. Only one patient with a fracture of the neck of the proximal phalanx of the little finger required revision surgery. No patient had pin site infection or pin loosening and the device was well tolerated by all patients. All fractures united and all the patients recovered a full range of motion at final follow-up. Conclusions: The MEFS is a reasonable alternative for unstable periphyseal fractures with good outcomes and avoids the risk of iatrogenic physeal injury from K-wire fixation. Level of Evidence: Level IV (Therapeutic).

A Deep Learning Model for Small-size Defective Components Detection in Power Transmission Tower

Unmanned Aerial Vehicle (UAV) inspection has gradually replaced manual inspection of transmission tower, which produces many images. While it is laborious and time-consuming to manually analyze these images, there are also challenges in automatically detecting small-size defective components such as bolts in transmission tower images, due to problems including complex background, small size, and many similar objects of bolts. In this paper, by virtue of multi-scale features and context information, we propose a deep neural network named Camp-Net (Context Information and Multi-Scale Pyramid Network) to identify bolts defect in transmission tower images. First, multi-scale feature fusion combines deep features and shallow features in convolutional networks to detect small-size bolts. Second, context information fusion puts the information around bolts into the detection network to remove the disturbance of complex background and similar objects. An image dataset containing defective bolts and normal bolts is constructed for model training and testing. Experimental results show that bolts with loose pins and bolts without pins among fittings in transmission tower can be accurately identified with the proposed model. The Average Precision (AP) of defective bolts detection of this model can be 11.4% higher than that of the commonly used high performance model, Faster R-CNN.

Observation of role of orthofix limb reconstruction system in with non-union with bone loss lengthening due to fresh fractures

The concept of Bifocal osteos1ynthesis is distraction at the Osteotomy site and compression at the non-union site with rhythmical distraction leads on the neo-osteogenesis and consolidation of cortectomy site. Transporting a segment of bone increases the vascularity of the fracture ends. Once the vascularity of the fracture ends increases, the infection will be eradicated and there will be healing of non-union. Daring transportation phase for bone lengthening their Wet pin tract infection and loosening in two cases for which pin Tension was done. ln all cases, neither there was infection at the Corticectomy site nor at the distraction sites. After a period of Waiting for consolidation to occur, the final result of the healing of the osteotomy was adequate in all cases. The cases (seven) with limb length discrepancy up to 2.5 cms in lower limb managed with modified footwear with heel and sole raise. One case of femur nonunion had angular deformity of 15 degrees. Six cases had knee stiffness; three cases had ankle stiffness. There was no neurological or vascular injury as a result of instrumentation. Bone healing index was (days of fixator use/centimeters of length gain) 69.1 days/cm.

TREATMENT INTERTROCHANTERIC FRACTURE OF FEMUR IN ELDERLY BY EXTERNAL FIXATION: PROSPECTIVE CASE-SERIES STUDY; IBN-SINA TRAINING HOSPITAL, BAGHDAD

Background: Internal fixation is gold standard in treatment of intertrochanteric fractures, but in patients with anesthesia or surgical hazards the external fixation should be explored as a safe approach to reduce operative time and complications risk. Objective: To assess the outcome of external fixation of an intertrochanteric fracture is in elderly patients with co-morbidities. Methods: Twenty-eight elderly patients with non-pathological fractures, closed, who were 65 years old or older, unsuited for surgery for a long period, and had chronic uncontrolled medical problems such as hypertension, diabetes mellitus, or heart disease were included in the study. Criteria for exclusion include reverse obliquity fractures, dementia, pathological fractures and prior hip fractures. Those patients treated with percutaneous external fixation under image intensifier from 2015 to 2020 in Ibn Sina Training Hospital in Baghdad. Results: At 1-year follow-up, 80% returned to pre-fracture ambulatory status. Average time to fixator removal was 12 weeks. There were no cases of pin loosening, breakage, or penetration of femoral head. All patients were evaluated clinically and radiologically for 24 months except 3 patients, 2 died 6 months’ post-operative due to causes unrelated to the surgery, and 1 lost follow up 3 months after surgery. Excellent and good results were found in 8 patients. The time of radiological union and fixator removal about 12 weeks. Pin tract infection occurred in most of the patients. Varus malalignment occurred in 20% of patients. Shortening ranged from 0 to 3 cm. Conclusion: External fixation of intertrochanteric fractures in elderly high-risk patients is a dependable, successful, and safe therapeutic option. Keywords: Intertrochanteric fracture, external fixator, elderly patient Citation: Alsudany FKI, Alhamashi AHS, Al-Abbody HHT, Ismael HA. Treatment intertrochanteric fracture of femur in elderly by external fixation: prospective case-series study; Ibn-Sina Training Hospital, Baghdad. Iraqi JMS. 2022; 20(1): 113-120. doi: 10.22578/IJMS.20.1.15

Pin-Related Complications in Computer Navigated and Robotic-Assisted Knee Arthroplasty: A Systematic Review

BackgroundComputer-assisted navigation (CAN) and robotic-assisted (RA) knee arthroplasty procedures carry unique risks of tracking pin-related complications. This systematic review aimed to quantitatively assess the incidence, timing, treatment, and clinical outcomes of all tracking pin-related complications following CAN and RA knee arthroplasty. MethodsA systematic review was performed using PubMed, Cochrane Central and Scopus databases. All clinical studies that documented pin-related complications associated with the use of CAN or RA for total or partial knee arthroplasty were included. Descriptive statistics were analyzed when data were available. ResultsThirty-six studies were included: 18 case reports (25 cases) and 18 randomized controlled trials, cohort studies and case series i.e., non-case reports (7,336 cases). The most common pin-related complication among case reports was fracture (n = 22; 81%). The overall rate of pin-related complications among non-case reports was 1.4%. The intraoperative and postoperative complication with the highest incidence were pin dislodgement (0.6%) and superficial pin site infections (0.6%), respectively. Most postoperative complications were related to the tibial site (69%). All complications were effectively treated and resolved at follow-up. ConclusionPin-related complications following CAN and RA knee arthroplasty are relatively uncommon. While pin loosening, superficial infections and fractures have been most commonly documented, other complications such as vascular injury, myositis ossificans, and osteomyelitis can also occur. The potential for pin-related complications should be considered by arthroplasty surgeons, especially during early stages of adoption. Further studies investigating patient risk factors for pin-related complications are warranted.

Complications of NA External Fixator in patients who Underwent Tibial Lengthening Surgery

Aim: To determine the spectrum of different complications during tibial lengthening procedure using NA external fixator in our patients at GMC, Gujranwala, and KEMU, Lahore, Pakistan. In addition, this study will also find significant factors associated with occurence of complications in NA fixator-assisted lengthening surgery. Methods: This was a cross-sectional study. The patients who underwent tibial lengthening procedure using NA external fixator were categorized into two categories: fixator complications group and no complications group. Statistical analysis was done using SPSS version 25. Independent sample T test and Chi-square test for independence were used for quantitative and qualitative variables respectively to determine their significant association with the occurrence of complications during tibial lengthening procedure. The p-values were taken statistically significant if &lt; 0.05. Results: Out of a total of 100 patients, 26% suffered loosening of pin, 2% breaking of pin, 2% loosening of pin, 2% loosening of clamp, 2% breaking of clamp, while 66% had no complications. 52% got skin reaction to pins. The occurrence of complications of NA external fixator was significantly lower at younger age (p=0.022). It has positive association with the number of pins inserted during procedure (p=0.037) and negative association with the duration of hospitalization (p=0.003). The complications of NA external fixator occurred more after left leg surgery as compared to after right leg surgery (p=0.012) and were associated with post healing pain (p=0.042). Conclusion: Skin reaction to pins was the commonest complication of NA external fixator in our studied population. The risk of complications of NA fixator had positive correlation with increasing age and number of pins inserted during tibial lengthening procedure. The duration of hospitalization was less while post-healing pain was more among patients in which complications of NA fixator occurred. Complications occurred relatively more after left leg surgery in comparison to right leg surgery. Minimum number of pins should be inserted during lengthening procedure especially in aged people to reduce fixator related complications and post-healing discomfort Keywords: Tibial lengthening surgery, NA external fixator, Complications of fixator, SPSS

To Study Functional Outcome for Upper Limb Phalanx Fracture Treated by JESS Fixator

Purpose: To study functional outcome for upper limb phalanx fracture treated by Joshi’s External Stabilizing System (JESS) fixator. Material and Methods: 68 patients were operated for Upper limb phalynx fracture in a tertiary health care setup with JESS fixator and were reviewed at 3 weeks, 6 weeks and 3months. After the procedure, the patients were assessed for the functional outcome using DASH (Disabilities or Arm, Shoulder and Hand) scoring scale. Results: Mean Adjusted DASH scores of the operated finger over consequent visits at 3 weeks, 6 weeks, and 3 months. We found that the mean adjusted DASH score improved in each consequent visit as compared to the first visit for all the joints (p&lt;0.001). Out of the total 68 study participants, 63 had no complications (92.65%). Only 5 study participants had complications, out of which 2 each had joint stiffness (2.94%) and superficial pin track infection (2.94%) while 1 had pin loosening (1.47%). Conclusion: From the results, we can safely conclude that JESS is an effective alternative treatment for fractures of the phalanges. It is cheap and easily available. Technically, also it is less demanding. Also there is a good functional outcome as suggested by our study findings in terms of improvement in the range of motion as well as the mean adjusted DASH scores over a period of three follow up visits planned at 3 weeks, 6 weeks and 3 months with very few complications.