Pin Loosening Research Articles

Clinical experience of biliary T tube of immobilization of peri-pin membrane in tibial Gustilo III fracture treated with vacuum sealant drainage combined with an external fixator

Objective:To determine the effects of an improved method of peri-pin membrane immobilization in tibial Gustilo type III fracture treated with vacuum sealant drainage (VSD) combined with an external fixator.Method:A biliary T tube of suitable size and type was cut into a certain long arm and cross arm which wrapping around a pin to improving traditional peri-pin VSD method. Eighty-six cases of Gustilo type III tibial fracture admitted from January 2016 to December 2019 were prospectively treated, of which 43 cases were treated using a traditional method of VSD (Traditional group) and 43 cases in which VSD treatment was enhanced (Improved group). The 2 groups were compared by some clinical indexes. Statistical software was then used for data analysis. P < .05 was considered statistically significant.Results:Compared with the Traditional group, the improved group significantly reduced granulation tissue growth time (day) (7.35 + 2.59 vs 11.14 + 2.54, P < .05), antibiotic use time (day) (6.67 + 2.39 vs 8.70 + 1.98, P < .05), operation time (min) (72.44 + 16.79 vs 85.47 + 17.44, P < .05) duration of hospital stay (day) (18.23 + 5.04 vs 21.53 + 4.79, P < .05), wound closure time (day) (9.23 + 2.69 vs 14.19 + 2.67, P < .05), air leakage around the fixed needle (3/43 vs 16/43, P < .05) and postoperative pain score (P < .05). Meanwhile, the white blood cell, C-reactive protein, erythrocyte sedimentation rate of 1 week and 2 weeks post-operation were also reduced after adopting the improved method (P < .05). The difference in infection around the fixation pin and pin loosening between the 2 groups was not significant.Conclusion:The biliary T tube was effctive in improving VSD combined with external fixation for the treatment of tibial Gustilo type III fractures. The materials are easy to obtain and straightforward to use and so is worthy of clinical promotion.

Effectiveness of anterior subcutaneous internal fixation (INFIX) in the management of potentially infected pelvis fractures

Background.Anterior plating is the treatment of choice in anterior pelvic ring fractures. In certain situations where pelvis fracture is associated with open wound, infection, abdominal injury or bladder injury - internal fixation with plate is contraindicated. Conventionally, external fixation is done in such cases. However, External Fixation is associated with pin tract infection, pin loosening, difficult wound care and less patient compliance. The present study was conducted to evaluate a possible ‘middle path’ between the two procedures.Methods.A prospective study was conducted from July 2017 to December 2019.18 adult patients with risk of infection were treated with INFIX. The patients’ data was collected on presentation, preoperatively, intra-operatively and post operatively. The patients were followed up with serial radiographs. Functional status was assessed using Iowa Pelvis Score. After radiological union, implant removal was performed. The patients were followed up for a minimum of 6 months after the removal surgery.Results.The average age of patients in present study was 39.55 years with a male predominance. 16 out of 18 patients were polytrauma cases with ISS more than 15.50% patients had Lateral Compression type of fracture. Radiological union was seen at an average of 3.5 months. After removal, 78% patients had excellent outcome and 22% patients had good outcome. The complications observed were LFCN irritation (27.78%) and asymptomatic heterotopic ossification (22%).Conclusion.Present study concludes that INFIX produces excellent outcome in pelvis fractures with risk of infection where anterior plating is contraindicated.

Halo pin positioning in the temporal bone; parameters for safe halo gravity traction.

Halo gravity traction (HGT) is increasingly used pre-operatively in the treatment of children with complex spinal deformities. However, the design of the current halo crowns is not optimal for that purpose. To prevent pin loosening and to avoid visual scars, fixation to the temporal area would be preferable. This study aims to determine whether this area could be safe for positioning HGT pins. A custom made traction setup plus three human cadaver skulls were used to determine the most optimal pin location, the resistance to migration and the load to failure on the temporal bone. A custom-made spring-loaded pin with an adjustable axial force was used. For the migration experiment, this pin was positioned at 10 predefined anatomical areas in the temporal region of adult cadaver skulls, with different predefined axial forces. Subsequently traction force was applied and increased until migration occurred. For the load-to-failure experiment, the pin was positioned on the most applicable temporal location on both sides of the skull. The most optimal position was identified as just antero-cranial to the auricle. The resistance to migration was clearly related to the axial tightening force. With an axial force of only 100N, which corresponds to a torque of 0.06 Nm (0.5 in-lb), a vertical traction force of at least 200N was needed for pin migration. A tightening force of 200N (torque 0.2 Nm or 2 in-lb) was sufficient to resist migration at the maximal applied force of 360N for all but one of the pins. The load-to-failure experiment showed a failure range of 780-1270N axial force, which was not obviously related to skull thickness. The temporal bone area of adult skulls allows axial tightening forces that are well above those needed for HGT in children. The generally applied torque of 0.5 Nm (4 in-lb) which corresponds to about 350N axial force, appeared well below the failure load of these skulls and much higher than needed for firm fixation.

The Effect of Increasing Fracture Site Stiffness on Bone-Pin Interface Stress and Foot Contact Pressure within the Equine Distal Limb Transfixation Cast: A Finite Element Analysis.

The aim of this study was to determine how increasing stiffness of fracture site tissues distal to the pins in an equine distal limb transfixation cast influences stress at the bone-pin interface, within the bones distal to the transcortical pins, and contact pressure between the foot and the cast. A transfixation cast finite element model was used to compare the bone-pin interface stress, pin stress, bone stress distal to the pins and contact pressure between the foot and the cast, using six stiffness values for a composite tissue block representing progressive stages of fracture healing. Increasing stiffness of the composite tissue block resulted in a decrease in the maximum stresses at the bone-pin interface, an increase in stresses distal to the transcortical pins and a decrease in the maximum pin stresses. As the composite tissue block stiffness was increased, contact pressure between the bottom of the composite tissue block and the cast increased and the stress patterns surrounding the pin holes became less focal. The findings of this study illustrate that with good foot to cast contact within a transfixation cast, increases in tissue stiffness due to progressive fracture healing are expected to reduce bone-pin interface stresses, and increase fracture site loading and stress. Increasing the contact pressure between the foot and the cast could reduce transfixation casting complications such as pin loosening, pin hole fracture and poor fracture healing, if these results transfer to ex vivo and in vivo settings.

The Application of the Taylor Spatial Frame for Deformity Correction at the Lower Extremity.

The Taylor Spatial Frame (TSF) can be used for the treatment of bone infections, deformity correction, contracture correction or to reconstruction by segment transportation. The TSF is very solid and allows even a full weight bearing mobilization. The TSF consists at least of two partial or full rings connected by six telescopic struts. It allows simultaneous correction of deformities in all possible planes without frame modification only by adjusting the strut length. The accurate frame assembly is very important to achieve a stable frame construct and to reduce pin infections, pin loosening or wrong deformity correction. Therefore, good knowledge of the frame assembly is necessary to achieve treatment success. This video demonstrates and teaches the key knowledge of TSF assembly using an artificial bone with varus deformity.

Complications of computer-assisted navigation in total knee replacement: retrospective cohort of eight hundred and seventy eight consecutive knees.

The main objective was to analyze the computer-assisted navigation (CAN)-specific complications that forced to switch to conventional procedure in primary total knee replacement (TKR). The secondary objective was to determine the influence of those complications on TKR short-term survival. Retrospective study of 878 primary TKR in 753 patients. Two consecutive versions of the OrthoPilot navigation system (Braun Aesculap, Germany) were used during the study time. Specific complications of CAN were defined as those due to the instrumentation (hardware or software failures), which were classified in one of two categories according to whether they occurred during the registration or tracking process. There were 20 (2.3%) complications related to the navigation system use that forced to switch to conventional surgery: in 11 (1.2%) knees due to loosening of the tracking pins, and in the other nine (1.0%) there were information system failures. There was a trend for a higher conversion rate to conventional surgery with the use of the first version of the software. There were no fractures, infections, or nerve injuries at the pin site. We found no differences in the distribution of baseline variables among those with or without conversion to conventional surgery. There was no significant difference (p = 0.488) in the two year survival between patients with or without conversion. CAN for primary TKR is a safe method with few specific complications that forced to switch from the navigated to the conventional procedure. Conversion to conventional surgery did not affect the short-term survival of TKR.

To evaluate the outcome of Ilizarov ring fixator using hybrid technique in Tibial trauma

Introduction: The management of infected nonunion of the tibia is challenging, particularly with segmental bone loss, multiple draining sinuses, poor soft tissue cover, osteopenia, adjacent joint stiffness, limb deformity, or multidrug-resistant polymicrobial infection. The Ilizarov method permits early rehabilitation and addresses all the problems such as non-union, infection, shortening, soft tissue loss and deformity simultaneously at single stage. The conventional all wire Ilizarov frame has certain disadvantages when done in diaphysis such as Muscle and tendon transfixation which leads to pain and contracture of adjacent joints, neurovascular injury and patient discomfort. Half pins used in hybrid Ilizarov causes minimal transfixation of the surrounding soft tissues and neurovascular injury thus causing less morbidity and increased range of motion. Methods: The present study was a prospective randomized open study in which aim was to evaluate outcome of Ilizarov ring fixator using Hybrid technique in tibial trauma. The study was conducted in 30 skeletally mature patients in Department of Orthopaedics, SGRD University of health sciences, Amritsar from July 2017 to May 2019. The patients were assessed clinically based on history and physical examination. Radiological evaluation using plain antero-posterior and true lateral radiographs of the involved leg was done and evaluated by ASAMI score and complications. Results: Mean age was 37.7 years. Out of 30 cases 24(80%) were male and 6(20%) were female. Right tibia was involved in 24 cases out of 30 cases. 29 cases had history of road side accident and 1 had history of fall from height. The bone results were excellent in 21 cases (70%), good in 6 cases (20%), fair in 2 cases(6.67%) and poor in 1 case(3.33%). Functional results were excellent in 17 cases (56.67%), good in 9 cases (30%) and fair in 4 cases (13.33%). No poor functional result was noted. In present study following complications were noted, limp in 12 cases(40%), ankle stiffness in 7 cases(23.33%), pin site infection in 9 cases(30%), limb oedema in 7 cases(23.33%), knee stiffness in 3 cases(10%), loosening of pins in 2 cases(6.67%), deformity in 2 cases(6.67%) and refracture in 1 case(3.33%). There was no complication of neurovascular injury, malunion, breakage of wires, axial deviation or limb length discrepancy. Conclusion: It is thus concluded in present study that with the use of hybrid Ilizarov fixator, bone results are same, functional results are better, post-operative pain is less, less neurovascular injury, decreased joint stiffness, increased range of movements as compared to conventional all wire Ilizarov fixator. Although studies state that pins increase the stiffness of the frame thus decreasing union rate, we found that union rate in hybrid Ilizarov fixator was same as compared to conventional all wire Ilizarov fixator. Thus we conclude that hybrid Ilizarov fixator is better than conventional Ilizarov fixator in all aspects. Keywords: hybrid ilizarov,half pins,ASAMI Score

Results of JESS (Joshi's External Stabilizing System) in Relapsed, Neglected and Neurogenic Clubfoot in an Age Group of 2-10 Years.

Joshi's External Stabilization System (JESS) is an external fixator based methodology to correct different deformities of club foot using differential distraction. 31 difficult clubfeet feet in 24 patients who were neglected, neurogenic or relapsed were treated using JESS between July 2013 to June 2015 with an average follow-up of 4. 2 years. There were 16 males and 8 females in an age group of 2-10 years. 30 feet belonged to the severe and most severe group as per the Dimeglio Scoring System. All patients achieved correction of all components of the clubfoot. However, one patient required tibialis anterior transfer for dynamic forefoot adduction at the end of treatment. The mean total duration in JESS fixation was 69.5 days/foot (range 44-123 days) and the mean time to achieve correction within JESS averaged 52 days. The deformities improved from a mean Dimeglio score of 14.06 to 2.93. The objective radiological assessment of the deformities revealed improvements in the talocalcaneal angle on AP view from 16.39° to 34.52° and on lateral view from 15.97° to 33.03°. The Talo-1st metatarsal angle (AP view) improved from 35.29° to 7°. Complications included 11 cases of superficial pin tract infection, two instances of pin loosening and a case of pin cut out. There were three cases of 1st metatarsophalangeal dislocation that were managed by reversing the process of distraction. JESS is an effective method for managing difficult clubfeet.

Results of JESS (Joshi’s External Stabilizing System) in Relapsed, Neglected and Neurogenic Clubfoot in an Age Group of 2-10 Years

Background. Joshi’s External Stabilization System (JESS) is an external fixator based methodology to correct different deformities of club foot using differential distraction. Material and methods. 31 difficult clubfeet feet in 24 patients who were neglected, neurogenic or relapsed were treated using JESS between July 2013 to June 2015 with an average follow-up of 4. 2 years. There were 16 males and 8 females in an age group of 2–10 years. 30 feet belonged to the severe and most severe group as per the Dimeglio Scoring System. All patients achieved correction of all components of the clubfoot. Results. However, one patient required tibialis anterior transfer for dynamic forefoot adduction at the end of treatment. The mean total duration in JESS fixation was 69.5 days/foot (range 44-123 days) and the mean time to achieve correction within JESS averaged 52 days. The deformities improved from a mean Dimeglio score of 14.06 to 2.93. The objective radiological assessment of the deformities revealed improvements in the talocalcaneal angle on AP view from 16.39° to 34.52° and on lateral view from 15.97° to 33.03°. The Talo-1st metatarsal angle (AP view) improved from 35.29° to 7°. Complications included 11 cases of superficial pin tract infection, two instances of pin loosening and a case of pin cut out. There were three cases of 1st metatarsophalangeal dislocation that were managed by reversing the process of distraction. Conclusion. JESS is an effective method for managing difficult clubfeet.

Inventive Methods Used to Study and Control Thermal Necrosis: A Review

Orthopedic surgeries use screw and plate fixations. Bone drilling is performed for smooth and minimum damage to bone surface during screw insertion. Bone drilling creates a hole with circular cross-section. This process involves cutting and material removal with a helical drill tool. Heat is generated at the drilling site due to cutting, shearing of bone material by drill tool and friction between drill tool and bone surface. Previous research studies found that if temperature at drilling site reaches 47°C and remains the same for one minute, irreversible cell damage i.e. thermal necrosis can occur. Thermal necrosis causes ring sequestrum around the pin; this leads to a vicious cycle involving secondary infection, discharge and pin loosening. This postoperative complication can only be rectified by removal of pin and sequestrum, curettage of the tract and pin replacement and so thermal necrosis- the root cause must be avoided and attended very seriously. To avoid thermal necrosis, postoperative complications and delay in patient rehabilitation, researchers are studying bone drilling in detail. In this review paper, a discussion is made on different innovative methods that are turning points in the study of thermal necrosis and the latest technologically improved equipment devised by researchers. These inventive methods have used experimental set ups, software-based simulations and training programs. The author also conducted experiments on female goat rib bone and based on these observations an improved drilling machine is suggested.

Curved “K” wires: The covert villain in circular external fixators

Context: Complications associated with “K” wires used in circular external fixators include intraoperative nerve and vessel damage, loss of tension, high rates of pin tract infection, and wire breakage. Aims: To investigate if insertion of “K” wire with a curvature is responsible, in part, for these complications. Settings and Design: This paper is a theoretical analysis of the forces and consequences of a tensioned curved wire on the bone, experimental measurement of the heat produced on inserting a curved compared to a straight (with a guide) wire into a bovine rib bone. Subjects and Methods: 1.8 mm K wires were drilled into two bovine rib bones using a battery-powered hand drill. The temperatures reached were recorded with a thermal camera. Statistical Analysis Used: Student's t-test. Results: (1) A tensioned curved wire would cut through the bone. (2) higher temperatures were reached when inserting a K wire in a curved manner than with a guide. (3) Drilling a curved wire initiates metal fatigue. It is theoretically possible to reach the forces needed to correct the curvature on the wire by “pinching” the wire near its insertion into the bone with the index and thumb of the non-drilling hand, but these forces far exceed the pressure pain threshold. In addition, the constantly changing force and direction would make the necessary proprioceptive changes almost impossible to follow. Conclusions: Theoretically and experimentally a curve on a K wire will increase vessel/nerve damage, thermal necrosis, pin tract infection, loosening, and loss of wire tension. Present-day method of “pinching” the end of the K wire to prevent curvature is probably inefficient and K wires should be inserted using a guide.

Importance of operative intervention in the treatment of clubfoot associated with congenital constriction Band syndrome

Background: Congenital talipes equino-varus is the most common congenital orthopaedic condition requiring intensive treatment. It has been associated with neuromuscular diseases and syndromes and specifically, CTEV associated with congenital constriction band syndrome forms the resistant variety of CTEV. This most often requires operative intervention in the form of postero-medial soft tissue release, JESS Fixator and Illizarov fixators. Material and Methods: 10 patients of less than 2 years with resistant CTEV associated with congenital constriction band syndrome, who required operative intervention were operated with JESS fixator at Govt. Medical College and Rajindra hospital, Patiala between august 2017 to august 2019. Following the correction, the assembly was held in the static position for the same period to allow for soft tissue maturation in the elongation position. Removal of the whole assembly was followed by well moulded above knee plaster cast in maximum correction for the same period followed by CTEV corrective shoes for 5 years to maintain correction and prevent recurrence. Results: Patients were evaluated using functional rating system for clubfoot, hospital for joint diseases, orthopaedic institute as excellent, good, fair and poor. 7 feet (70%) were graded as excellent, 2 feet (20%) were graded as good, 1 feet (10%) as fair and 1 feet (10%) as poor. In this study, 1 feet (10%) had persistent oedema, 2 feet (20%) had flexion contractures of toes, 1 feet (10%) had tibial loosening of pin, 1 feet (10%) had rocker bottom foot and none of the feet had skin necrosis. Conclusion: Congenital talipes equino-varus in a child of congenital constriction band syndrome forms the resistant variety of of CTEV, in which operative treatment is the mainstay of treatment. Joshi’s external stabilisation system has proved to be an good treatment option in such cases.

A Novel External Fixation Technique for Injuries of the Proximal Interphalangeal Joint.

Digital external fixation is often used for the management of complex injuries involving the proximal interphalangeal joint, including pilon fractures of the middle phalanx base and unstable fracture-dislocations. Several dynamic "homemade" constructs have been described which utilize only K-wires and rubber bands and allow early range of motion within the construct. Although these constructs are inexpensive and their application is fairly straightforward, their designs pose a few potential problems when the construct is stressed during rehabilitation efforts. These designs utilize a blocking K-wire which relies on pin-to-pin contact to maintain reduction and creates unnecessary friction that can impede motion and result in pin loosening in bone. Furthermore, rubber band rupture can occur and destabilizes the construct. Here we present a novel technique which utilizes only K-wires and K-wire caps, provides adequate joint distraction and stabilization throughout the arc of motion, and avoids the aforementioned pitfalls of existing designs.

Une simple fixation externe à bas prix pour les fractures luxations de la main

Fracture dislocation is one of the most common and challenging problems in hand surgery. Pin fixation is the most common fixation device in the hand but sometimes we need to use external fixators in hand fractures and diseases. Commercial hand external fixators are expensive and sometimes they are not available. Since it has been presented some alternative solutions for this technique to overcome these problems, like Suzuki technique, Pin stabilizing with syringe or orthopedic cement and so on. We introduce a new alternative for this treatment, which is simple, available and with low price. Pi frame can be used as static or dynamic external fixator. From June 2016 to February 2018, 24 patients with hand and finger problems and trauma underwent external fixation stabilizing with Pi frame, including 8 phalangeal fracture, 6 PIP fracture dislocations, 7 metacarpal fracture and 3 congenital diseases. Eighteen cases as static and 6 cases as dynamic fixator. Technique For static external fixator we inserted the 1–1.5 mm pins at proper sites for example perpendicular to fracture lines and bent them to be caught with electric strip terminal block (Venus industrial group, Iran). For dynamic type, the proximal pin inserted parallel to articular surface and in the center of rotation of the adjacent joint. The pin bent 90 degrees and attached to the distal pins with a strip terminal block. We had one patient with delayed union, 6 patients with different degrees of limitation of joint motion. We had not seen any cases with pin tract infection, hyper-sensibility to the frame pin loosening or complaint of the appearances of the device. Fracture dislocation in hand is difficult to manage. Ilizarov and other external fixators has been evolved to overcome this problem but they are expensive and they are not available in some centers. Strip terminal block is a low price device available in all electrical stores. As a temporary external fixator it needs no bio-compatible studies. It is suitable everywhere but specially in area with lower outcomes and economic sanction. Pi mini external fixator is an available, simple with low price device with almost satisfactory results in difficult hand problems.

Outcome evaluation of new calcium titanate schanz-screws for external fixators. First clinical results and cadaver studies.

External fixators are important for correcting length discrepancies and axis deformities in pediatric or trauma orthopedic surgery. Pin loosening is a common pitfall during therapy that can lead to pain, infection, and necessary revisions. This study aims to present clinical data using calcium titanate (CaTiO3) Schanz screws and to measure the fixation strength. 22 titanate screws were used for external fixators in 4 pediatric patients. Therapy was initiated to lengthen or correct axial deformities after congenital abnormalities. The maximum tightening torque was measured during implantation, and the loosening torque was measured during explantation. In addition, screws of the same type were used in a cadaver study and compared with stainless steel and hydroxyapatite-coated screws. 12 screws of each type were inserted in four tibias, and the loosening and tightening torque was documented. The fixation index in the in vivo measurement showed a significant increase between screw insertion and extraction in three of the four patients. The pins were in situ for 91 to 150 days, and the torque increased significantly (P = 0.0004) from insertion to extraction. The cadaveric study showed lower extraction torques than insertion torques, as expected in this setting. The calculated fixation index was significantly higher in the CaTiO3 group than in the other groups (P = 0.0208 vs. HA and P < 0.0001 vs. steel) and in the HA group vs. plain steel group (P = 0.0448). The calcium titanate screws showed favorable fixation strength compared to HA and stainless steel screws and should be considered in long-term therapy of external fixation.

Application of individualized transiliac crest nail-grafting guide plate in deep pelvic external fixator implantation

To explore the application of individualized transiliac crest nail-grafting guide plate prepared by computer-aided design and three-dimensional (3D) printing technology in deep pelvic external fixator implantation. Five patients with pelvic fractures were collected between May 2017 and February 2018. There were 4 females and 1 male with an average age of 52 years (range, 29-68 years). Pelvic fractures were classified as type B in 3 cases and type C in 2 cases by Tile classification. The interval between injury and operation was 6-14 days (mean, 9 days). The preoperative CT images of pelvic fractures were collected. The data was reconstructed by 3D imaging reconstruction workstation. An individualized transiliac crest nail-grafting guide plate was designed on the virtual 3D model. The individualized transiliac crest nail-grafting guide plate and the solid pelvic model were produced with the 3D printing technology. The individualized transiliac crest nail-grafting guide plate was used for intraoperative deep pin position on iliac crest after the preoperative simulation. The follow-up CT scans were used to determine the differences in distance from anterior superior iliac spine, convergence angle, and caudal angle between the preoperative plan and postoperative measurement. During the operation, the individualized transiliac crest nail-grafting guide plate was used to guide the placement of 20 pins. X-ray film and CT examination showed that all pins were well positioned. The average depth of pins was 83.16 mm (range, 70.13-100.53 mm). Fitted 3D reconstruction images showed that the entry point and orientation of the pins were all consistent with preoperative schemes. Compared with the planned nail path, there was no significant difference in the distance from anterior superior iliac spine, convergence angle, and caudal angle in the actual nail path ( P>0.05). No loosening and rupture of pin, no damage of blood vessels and nerve, and shallow or deep infection occurred during 3 months follow-up, and the incisions healed by first intention. All patients were satisfied with the treatment process. The ranges of motion of hip and knee were normal, and the visual analogue scale (VAS) score was 0-3 (mean, 0.5). The individualized transiliac crest nail-grafting guide plate technique is the improvement of traditional technique. It can increase accuracy and effective depth of pin position, enable patients to obtain pelvic mechanical stability quickly after operation, and reduce the risk of complications related to nail path.

Effects of Vacuum Sealing Drainage Combined with Ilizarov Bone Transport Technique in the Treatment of Tibial Traumatic Osteomyelitis.

BackgroundThe aim of this study was to analyze the efficacy of vacuum sealing drainage combined with Ilizarov bone transport technique in the treatment of tibial traumatic osteomyelitis and risk factors for postoperative pin infection.Material/MethodsWe enrolled 78 patients with tibial traumatic osteomyelitis admitted at the First People’s Hospital of Kashgar from January 2015 to September 2017 and treated with vacuum sealing drainage combined with Ilizarov bone transport technique.ResultsAfter combined treatment, SAS and SDS scores decreased significantly, while SF-36 scores increased significantly. Comparisons showed that there were significant differences in the scores of patients after treatment (P<0.05). Univariate analysis showed that there were no significant differences in gender, BMI, hypertension, diabetes mellitus, COPD, smoking index, alcohol abuse history, or residence (P>0.05). There were significant differences in age, fracture type, fixation type, pin loosening, and indwelling time between the 2 groups (P<0.05). Multivariate logistic analysis showed that age, fracture type, fixation type, pin loosening, and indwelling time were independent risk factors for pin infection. Age, fracture type, fixation type, pin loosening, and indwelling time are independent risk factors for pin infection in patients with tibial traumatic osteomyelitis.ConclusionsCombination of vacuum sealing drainage with Ilizarov bone transport technique can effectively improve the condition of tibial traumatic osteomyelitis, improve the quality of life of patients, and reduce the occurrence of adverse emotions of patients. Age, fracture type, fixation type, pin loosening, and indwelling time are independent risk factors for pin infection in patients with tibial traumatic osteomyelitis.

Triceps-sparing Posterior Approach for Supracondylar Humeral Fracture in Children.

The most common pediatric elbow fracture is supracondylar humeral fracture which accounts for 60% of elbow fractures in children. The aim of this study was to evaluate the results of open reduction and internal fixation of type III supracondylar humeral fractures using a Triceps sparing posterior approach. In total, 98 patients were evaluated from June 2007 to 2014. According to the results, the mean age of the patients was 6.4 years. The ratios of males to females and the right to left hand were 2.06 and 2.26, respectively. Totally, 82% of fractures happened in the dominant hand which was right. The patients underwent surgery within approximately 50.16 hours after injury. Anatomic reduction and internal fixation were performed under direct vision with no need for image intensifier. The mean time of follow-up was 14.3 months, and all fractures healed clinically and radiologically. Moreover, the maximum lack of an extension was 15° and the obtained mean was 3.5°. Additionally, the mean final Bauman angle difference with healthy elbow was determined at 2.4°. The rate of complications was 19.3%, including pin tract infections (7%), pin loosening (3%), heterotopic ossification (4%), and wound dehiscence (1%). Furthermore, there were 4 cases (4%) of anterior interosseous nerve palsy, two of which happened before surgery, and the other two following the surgery. All of these complications were resolved within 3 to 10 weeks spontaneously. This approach helped preserve the extensor mechanism and ulnar nerve intact to have an acceptable skin scar esthetically along with satisfactory postoperative function.

Results of modified JESS augmentation for fracture proximal humerus stabilized with percutaneous K-wires

Background: Proximal Humeral fractures are defined as fractures occurring at or proximal to surgical neck of Humerus1. Various methods are used for treating such conditions with mixed results. Closed reduction & percutaneous pinning with JESS augmentation with interconnecting double frames have been described for such fractures with satisfactory results. We aim to modify the same by mounting the JESS in a single frame with biplanar configuration review our results. Material and Methods: Total 15 patients with proximal humeral fractures were treated from 2016 to 2017 by fixation with JESS & K-wires. There were 10 (62.5%) males and 5 (37.5%) females, with a mean age of 57.5 years. Road traffic accident (RTA) was the most common mode of injury in patients less than 60 years old (4 out of 7), while fall on the ground was the most common cause in fractures in elderly patients (age>60 years, i.e. 6 out of 8). Displaced (more than 45° of angulation or >1cm of displacement) 2 and 3 part fractures and patients of age >20 years were included in the study. The fixator was removed when there was clinical (subsidence of pain) and radiological signs of union (bridging callus in 3 out of 4 cortices). Shoulder function was assessed using Constant scoring system. Result: 100 % union seen with duration ranging from 6weeks to 8 weeks followed by JESS removal. According to Constant score 3 cases (20%) showed excellent result, 9 cases (60%) showed good result, 2 cases (13.3%) showed fair result & 1 case(6.7%) showed poor result which may be due to noncompliance in physiotherapy & early pin loosening. Conclusion: External fixation with JESS & K-wires is an alternative cost effective option to treat Neer’s 2 & 3 part fractures, enables early mobilization & achieves safe healing with less soft tissue dissection. Keywords: Proximal humerus fractures, External fixator, JESS.

Clinical outcomes of 119 miniature- and toy-breed dogs with 140 distal radial and ulnar fractures repaired with free-form multiplanar type II external skeletal fixation.

To report the clinical outcomes of miniature- and toy-breed dogs with primary and previously treated distal radial and ulnar fractures (RUF) treated with a free-form multiplanar type II external skeletal fixation (ESF). Retrospective study. One hundred nineteen dogs with 140 distal RUF. Medical records (2003-2017) were reviewed for dogs weighing up to 7 kg that had been treated for distal RUF with a free-form multiplanar type II ESF. Data collected included signalment, fracture location and configuration, fracture reduction, intraoperative realignment, time to bone union and implant removal, duration of destabilization and postoperative splint, complications, and outcomes. Follow-up consisted of clinical and radiographic evaluation or telephone interview. All fractures healed, with a median time of 60 days, and entire ESF was removed, with a median time of 89 days. Major complications occurred in four fractures: premature pin loosening, elbow subluxation, osteomyelitis, and delayed union. Minor complications occurred in 52 fractures (61 events). All dogs had a successful return to normal limb function at final follow-up (median, seven months; range, 2-97). All primary and previously treated distal RUF in miniature- and toy-breed dogs healed and allowed return to normal function after fixation with a free-form multiplanar type II ESF. The free-form multiplanar type II ESF provides an alternative for minimally invasive fixation of distal RUF in miniature- and toy-breed dogs that facilitates fracture reduction, intraoperative realignment, adequate initial fixation stability, destabilization, and implant removal.