Pin Insertion Research Articles

Percutaneous pinning for treating distal radial fractures in adults.

Background Fracture of the distal radius is a common clinical problem. A key method of surgical fixation is percutaneous pinning, involving the insertion of wires through the skin to stabilise the fracture. Objectives To evaluate the evidence from randomised controlled trials for the use of percutaneous pinning for fractures of the distal radius in adults. Search methods We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (September 2006), the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and other databases, conference proceedings and reference lists of articles. No language restrictions were applied. Selection criteria Randomised or quasi-randomised controlled clinical trials involving adults with a fracture of the distal radius, which compared percutaneous pinning with conservative treatment, or different aspects of percutaneous pinning. Data collection and analysis Two authors independently assessed and extracted data from the included trials. Some pooling of data was undertaken for one comparison. Main results Thirteen trials, involving 940 generally older adults with dorsally displaced and potentially or evidently unstable distal radial fractures, were included. Methodological weaknesses among these trials included lack of allocation concealment and inadequate outcome assessment. Factors affecting the applicability of trial evidence included inconsistent fracture classification, variations in outcome assessment and incomplete reporting. Six heterogeneous trials compared percutaneous pinning with plaster cast immobilisation. Across-fracture pinning, used in five trials, was associated with improved anatomical outcome and generally minor complications. There was some indication of similar or improved function in the pinning group. One quasi-randomised trial found an excess of complications after Kapandji pinning. Three trials compared different methods of pinning. Two trials found a higher incidence of complications after Kapandji fixation compared with two methods of across-fracture fixation. The third trial provided inadequate evidence for modified Kapandji fixation versus Willenegger fixation. Two small trials comparing biodegradable pins versus metal pins found a significant excess of complications associated with biodegradable material. Two small trials compared plaster cast immobilisation for one week versus for six weeks after surgery. One trial found duration of immobilisation after trans-styloid fixation did not have a significant effect on outcome. More complications occurred in the early mobilisation group after Kapandji pinning in the second trial. Authors' conclusions Though there is some evidence to support its use, the precise role and methods of percutaneous pinning are not established. The higher rates of complications with Kapandji pinning and biodegradable materials casts some doubt on their general use.

Insertional characteristics of three types of transfixation pin taps in third metacarpal bones from equine cadavers.

To compare heat generation and mechanical bone damage achieved with 2 tapered and 1 cylindrical transfixation pin taps in third metacarpal bones from equine cadavers. 18 pairs (36 specimens) of third metacarpal bones from euthanized horses with no known metacarpal disease. In each bone, an investigator drilled 3 holes for placement of a 6.3-mm cylindrical transfixation pin, a 6.3-mm tapered pin using a prototype tapered tap, and a 6.3-mm tapered pin using a revised tapered tap. One bone of each pair was tapped by hand and the other with an electric drill. Temperatures of the drill bits, reamers, and taps were measured and used to compare heat generation among tap groups and tapping methods (hand vs power tapping). Macrodamage (all bone pairs) and microdamage (6 bone pairs) were assessed. The revised tapered tap resulted in less heat generation and less total thread microdamage, compared with the prototype tapered and cylindrical taps. Power tapping created less bone damage but higher temperatures than did hand tapping for all bone groups. The revised tap design for tapered pin insertion was superior to the prototype tap design and yielded similar or less bone damage than achieved with cylindrical pin insertion in equine third metacarpal bone specimens. We recommend careful hand tapping for tapered pin insertion rather than power tapping, which generated greater heat. The revised tapered tap could be expected to perform better than a cylindrical pin tap in terms of thermal and mechanical microdamage and should be used for insertion of tapered transfixation pins.

Safe zone of pin insertion for nonbridging external fixators in distal radial fractures: MRI analysis

BackgroundOf the anatomical reduction and fixation methods used to treat distal radius fracture, non-bridging external fixation has the advantage of enabling early wrist motion. The surgical technique relies on successful placement of the pin in individual fracture fragments. The present study aimed to identify the safe zone of pin insertion for a non-bridging external fixator into the distal radius that avoids metal impingement of extensor tendons. MethodsThe width and length of the septal attachments of the extensor retinaculum were measured on axial MR images of 62 wrists. ResultsThe 2–3 septum was the widest and longest, with a width of 2–7 mm and a location 0–36 mm proximal to the wrist joint. The width of the 1–2 septum was 2–6 mm, and was widest at 10 mm proximal to the joint. The 1–2 septum was triangular-shaped, while the 2–3 septum was oval-shaped. The 3–4 and 4–5 septa had narrow attachments and were adequate for pin insertion (with a pin 1–2 mm in width) at a position less than 8 mm proximal to the wrist. The width of the 1 R septum (radial to the 1st septum) was 2–6 mm at the radiovolar aspect of the wrist. ConclusionsThere were two safe pin insertion sites; the first was safe at the distal aspect only (8–10 mm proximal to the wrist) and included the 1–2, 3–4, and 4–5 septa, while the second was safe from 0 mm to 32–38 mm proximal to the wrist and included the 1 R and the 2–3 septa. The 1 R septum had adequate size for use as a new pin insertion site that aligns in the internervous plane and has minimal risk of superficial radial nerve injury.

Analysis of orthopedic treatment of patients with stump pins inserts with artificial crown in significant destruction of the clinical dental crown: the data of archival materials of the dental clinic

The aim of the article is to analyze the orthopedic treatment of patients with a lack of clinical tooth crowns by means of stump pin inserts with an artificial crown presented in the archival materials from the dental clinic of Samara.
 Research methods. Health records of dental patients and the orthopaedic work orders of the Dental Clinic No. 2 of the city of Samara over the period of 20152019 were analyzed.
 Results. Of the total number of patients (142,394 people), 5370 patients underwent a stump pin insert to restore a missing tooth crown. A total of 5802 pin stump tabs were made for these patients. 524 patients (10.09%) had complications. Most complications were observed in the lateral group of patients with prosthetic teeth (62.18%). Discementation of crowns from stump pin inserts was the main complication (53.32%). Ceramic crown chipping from metal-ceramic crowns was observed in 6.46% of all complications.

Sphenopalatine ganglion block: Intranasal transmucosal approach for anterior scalp blockade - A prospective randomized comparative study.

Background and Aims:Peripheral nerve blocks in neurosurgical practice attenuate most stressful responses like pin insertion, skin, and dural incision. Scalp block is conventionally the blockade of choice. Further studies for less invasive techniques are required. Intranasal transmucosal block of the sphenopalatine ganglion has shown promising results in patients with chronic headache and facial pain. The primary objective of our study was to compare the gold standard scalp block and bilateral sphenopalatine ganglion block (nasal approach) for attenuation of hemodynamic response to pin insertion. Secondary objectives included hemodynamic response to skin and dural incision.Material and Methods:After IRB approval and informed consent, a prospective randomized comparative study was carried out on 50 adult patients undergoing elective supratentorial surgery. The hemodynamic response to pin insertion, skin incision, and dural incision was noted in both the groups. The data was analyzed with NCSS version 9.0 statistical software.Results:The HR and MAP were comparable between the groups. Following dural incision MAP was significantly lower at 1,2,3,4,5 and 10 min in group SPG whereas in group S it was significantly lower at 1 and 2min. (P = 0.02 at T1, P = 0.03 at T2).Conclusions:Concomitant use of bilateral SPG block with general anesthesia is an effective and safe alternative technique to scalp blockade for obtundation of hemodynamic responses due to noxious stimulus during craniotomy surgeries.

Development of tensile fixture with corrugated structure sheet and estimation of tensile strength of glass fibre fabrics based single face corrugated structure sheet

This work aims to reveal the tensile characteristics of Glass Fibre fabrics based single face corrugated Structure Sheet (GFSS) by developing a pressure-adjustable fixture in the machine producing direction of GFSS. In order to set the fixture quick-ready and stable, the effects of several set-up conditions on the tensile behavior of GFSS were investigated. As the set-up condition, a wavy aluminum block fitted to the surface trace, insertion of multiple flexible pins into wave holes, and double-sided tapes attached on the upper/lower surfaces were discussed by changing the number of pins N, and also a few of instant adhesives was dipped on the clamped/pressured zone of GFSS (the reinforced model). Through this study, the followings were revealed. To use multiple polystyrene pins and several pieces of double-sided tapes in the proposed fixture contributes to make the tensile line force stable (as the simple model: without any instant adhesives on the clamped zone). To perform the breakage of liner and wave layers in the area of the gauge span, the reinforced model is usable when choosing N > 1. Investigating the tensile response, the strength (peak maximum line force) and the elongation limit of the liner and wave layers were revealed, respectively. By dipping instant adhesives on the clamping zone when N > 6, the combination resistance of liner and wave braiding structure was actualized.

Evaluation of Threaded External Skeletal Fixation Pin Insertion with and without Predrilling in Avian Bone.

The aim of this study was to document the effects of positive-profile threaded external skeletal fixation (ESF) pin insertion without predrilling on heat generation, structural damage and pullout strength in avian bone than that with predrilling. This study was an ex vivo study. Twenty paired tibiotarsi and 40 paired humeri from 20 Mallard duck cadavers were used. Specimens were randomized to have positive-profile threaded ESF pins placed with or without predrilling insertion sites. Heat generation (maximum-baseline temperature) was measured during drilling and pin insertion with infrared thermography. Structural damage (gross trans-cortical damage and thread quality) was evaluated and scored using a visual analog scale (VAS). Mechanical testing was performed to evaluate pullout strength of inserted pins. VAS scores for trans-cortical surfaces were significantly higher than for cis-cortical surfaces; however, no difference was noted between predrilled and non-predrilled specimens. No significant difference in heat generation or pullout strength was noted between pins placed with and without predrilling. Pin insertion without predrilling in avian humeri and tibiotarsi does not cause significantly more structural damage or heat generation, or reduced pullout strength, compared with predrilling. Overall, our results indicate that predrilling prior to ESF pin placement provides no obvious advantage in avian bone.

Histopathological and Radiographic Features of the Postoperative Osteolysis Surrounding the PLLA Pin After the Fixation of the Osteochondral Fragment for Osteochondral Lesion of the Talus

Category:Ankle, Arthroscopy, Basic Sciences/BiologicsIntroduction/Purpose:Several surgical options are available for the treatment of osteochondral lesion of the talus (OLT). Fixation of the osteochondral fragment could be performed for large lesions with the remaining articular cartilage surface of OLT. Bioabsorbable bone fixation devices, especially those made of poly-L-lactic acid (PLLA), can be used for fixation of the osteochondral fragment. Postoperative osteolysis surrounding the PLLA pins is occasionally observed; however, the significance and details of the event are not fully understood. This study aimed to elucidate the association among osteolysis surrounding the PLLA pins, histopathological findings of OLT, and preoperative computed tomography (CT) values of the pin fixation sites.Methods:This retrospective analysis included 20 patients with OLT (12 males and 8 females; mean age, 21.8 years). The tissue of the osteochondral fragment was intraoperatively collected using a bone biopsy needle. Subsequently, fixation of the osteochondral fragment was performed through the biopsy hole using a PLLA pin. Osteolysis surrounding the PLLA pin was assessed postoperatively by magnetic resonance (MR) imaging. The patients were then divided into an osteolysis and non-osteolysis group. Histopathologically, 5 parameters (trabecular bone loss, empty lacunae, inflammatory granulation tissue, cartilage like tissue, and osteoclast) were assigned scores of 1–3 points (negative, mild, and severe). The score was calculated as minimal (5 points) or maximal (15 points) via hematoxylin and eosin staining. The CT values around the pin insertion site on the postoperative MR images were measured using the region of interest on the preoperative CT images. The average values were calculated from consecutive 3 images.Results:Postoperative osteolysis and non-osteolysis surrounding the PLLA pin were observed in 9 and 11 patients, with a mean age of 22.8 and 21.0 years and a mean number of PLLA pins of 2.7 and 2.4, respectively. No significant differences were found between the two groups. Histopathological evaluation revealed that the osteolysis group had a significantly higher pathological score of 10.1 (SD, 2.0) than the non-osteolysis group, which had a score of 6.1 (SD, 1.0; P=0.0003). Preoperative CT images of the osteolysis and non-osteolysis groups showed mean CT values of 364.3 HU (SD, 78.0) and 463.6 HU (SD, 133.5) (p=0.054), respectively, on the coronal images, and 339.2 HU (SD, 64.2) and 467.8 HU (SD, 109.9) (p=0.0049), respectively, on the sagittal images.Conclusion:Intraoperative biopsy of the OLT allowed for histopathological evaluation in the same location as the site of PLLA pin fixation. Our findings suggest that the preoperative environments of the cancellous bone under the OLT affect osteolysis surrounding the PLLA pin postoperatively. Additionally, low preoperative CT values under OLT can assist in the prediction of osteolysis surrounding the PLLA pin, and another fixation method, such as a bone peg, should be considered for the fixation of the osteochondral fragment in these patients.

Safe Supra-Acetabular Pin Insertion in Relation to Intraosseous Depth.

In pelvic fractures, dysfunction of the pelvic ring is often stabilized with supra-acetabular pin insertion. In existing literature, there are heterogeneous indications on proper pins selection and inclinations. Therefore, this study aimed to quantify the narrowing of safe pin corridors in the transverse and sagittal planes with increments of intraosseous screw depths. A computer algorithm created cross-sections over three-dimensional pelvic reconstructions at sagittal inclinations from 45° cranial to 45° caudal in 5° increments. Templates of screw depths spanning 60-120 mm in 15 mm increments were disposed in the transverse plane from 45° medial to 45° lateral. Each intraosseous screw depth and transverse angle were evaluated for intraosseous containment to evaluate ranges narrowing with increasing screw depths. The 60-mm depth resulted in the largest sagittal range (60.9° ± 6.9°) and transverse range (27.5° ± 4.1°) at 30° caudal. Increasing depths by 15 mm resulted in ranges being significantly different from one another (p < 0.01). The sagittal plane of 20° cranial had the highest frequency of insertion for all depths, while transverse ranges were narrowed (p < 0.01). Bisecting angles were similar for sagittal planes 20° cranial to 30° caudal with an average of 27.9° ± 1.2° (p ≥ 0.115). In conclusion, while 60 mm depths can be inserted with the highest discretion, 15 mm increments in depth significantly reduce safe ranges. Screws depths above 90 mm have low frequencies of insertion, should be inserted more cranially and must be considered prone to breaching. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:1790-1797, 2019.

Effects of a task-based biofeedback training program on improving sensorimotor function in neuropathic hands in diabetic patients: a randomized controlled trial.

Symptoms of diabetic hands have been gradually elucidated, however the interventions for these hand problems are typically underemphasized. Few studies have discussed intervention effects on sensorimotor problems in hands, which prevent diabetic patients from executing their daily routines and lower their quality of life (QoL). This study has investigated the effects of task-based biofeedback training compared with home-based programs on sensorimotor function and QoL in diabetic patients with neuropathic hands. A single blind randomized controlled trial. Outpatient clinic at a university hospital. Thirty-eight patients with diabetic hand neuropathy whose sensorimotor functions were impaired based on screening with a pinch-holding-up activity (PHUA) test. Participants were randomly assigned to either a computerized evaluation and re-education biofeedback (CERB) (N.=20) or a home-based (tendon gliding exercise in conjunction with resistive exercise) (N.=18) group. The primary outcome was sensorimotor control of a hand using the PHUA test. Secondary outcomes included changes in Semmes-Weinstein monofilament, two-point discrimination, the Purdue Pegboard test and a self-reported QoL questionnaire. The measurements were conducted before and after a 6-week treatment program. The CERB group significantly improved efficiency in pinch force output during the PHUA test by reducing the percentage of maximum pinch strength (change from 34.5±11.66 to 30.7±10.16%, P=0.001), and there was a statistically significant between-group difference (P=0.00, 95% CI: -12.59 to -3.34, F=9.42). The CERB group showed superior treatment effects as compared to the control group on the two-point discrimination results (P=0.01) as well as the pin insertion subtests in the Purdue pegboard test (P=0.01). The QoL results also revealed significant between-group differences in several items of the Diabetes-39 (P<0.05). This study showed that a task-based biofeedback training program provides superior benefits for restoration of hand sensorimotor functioning in diabetic patients as compared to a home-based program combining tendon gliding exercise and resistive exercise. Using task-based biofeedback training as one of the rehabilitation strategies may be an effective approach for restoration of sensory function, precision pinch performance, hand dexterity, and QoL for patients with diabetes-related neuropathy.

The Flexion-Type Supracondylar Humeral Fracture in Children: A Review.

» A flexion supracondylar fracture of the humerus is an uncommon fracture in children and accounts for only 1% to 10% of all supracondylar fractures.» The injury is caused by a direct fall on the point of the elbow, causing hyperflexion at the elbow, rather than by a fall on an outstretched hand, which is the mechanism in an extension-type fracture.» The ulnar nerve is at higher risk of injury in this fracture by the spike of the proximal fragment or by entrapment in the callus.» This fracture is inherently unstable, leading to difficulty in maintaining reduction intraoperatively and difficult Kirschner wiring in the extension position in which the reduction is achieved.» Kirschner wiring can be done in a flexed position of the elbow by utilizing a push-pull method, a temporary transolecranon pin, or a Kirschner wire as a joystick in the distal fragment to achieve and maintain reduction before the insertion of the final pins.

Scalp block with bupivacaine and ropivacaine for attenuation of haemodynamic response to head pinning in neurosurgical patients: An observational study

Objective: Present study was performed to compare the effectiveness of bupivacaine and ropivacaine for scalp block on the haemodynamic response during skull-pin insertion. Materials and Method: Ninety patients who underwent elective craniotomy were divided into two equal groups (n=45). After routine induction, patients were intubated. All the patients received scalp blocks with 20 ml of either 0.5% bupivacaine (group B) or 0.5% ropivacaine (group R) approximately 5 minutes before skull-pins insertion. Heart rate (HR) and mean arterial pressure (MAP) were recorded at 60sec, 120 sec and 300 sec following head pin insertion. Results: MAP and HR were stable during and after head pinning in both the groups at all time points. Conclusion: Both bupivacaine and ropivacaine for scalp block are equally effective for blunting hemodynamic responses during head pinning. Ropivacaine being less toxic can be a safe alternative for scalp block. Keywords: Anaesthesia, Local anaesthesia, Scalp block, Bupivacaine, Ropivacaine, Hemodynamic.

A Touch-Observation and Task-Based Mirror Therapy Protocol to Improve Sensorimotor Control and Functional Capability of Hands for Patients With Peripheral Nerve Injury.

To develop a practical program in the early phase after nerve repair for more rapid return of function. To investigate the effects of touch-observation and task-based mirror therapy on the sensorimotor outcomes of patients with nerve repair. An assessor-blinded study with a randomized controlled design. University hospital. We recruited 12 patients with median or ulnar nerve repair between the level of midpalm and elbow referred by the plastic surgeons. The patients were randomized into touch-observation and task-based mirror therapy or control groups, and both groups received training for 12 wk. The Semmes-Weinstein monofilament (SWM) test, two-point discrimination test, Purdue Pegboard Test (PPT), Minnesota Manual Dexterity Test (MMDT), and pinch-holding-up activity test were assessed at pretreatment, immediately after treatment, and 12 wk after the last treatment. The experimental group showed greater improvements in the results of the pinch-holding-up activity test and the PPT Unilateral Pin Insertion, Bilateral Pin Insertion, and Assembly subtests. However, change on the SWM test revealed no significant difference between the two groups. Touch-observation and task-based mirror therapy is an effective but low-cost treatment protocol to optimize sensorimotor control and functional capability of the upper limb in patients with peripheral nerve injury.

Are multiple views superior to a single view when teaching hip surgery? A single-blinded randomized controlled trial of technical skill acquisition.

PurposeSurgical education videos currently all use a single point of view (POV) with the trainee locked onto a fixed viewpoint, which may not deliver sufficient information for complex procedures. We developed a novel multiple POV video system and evaluated its training outcome compared with traditional single POV.MethodsWe filmed a hip resurfacing procedure performed by an expert attending using 8 cameras in theatre. 30 medical students were randomly and equally allocated to learn the procedure using the multiple POV (experiment group [EG]) versus single POV system (control group [CG]). Participants advanced a pin into the femoral head as demonstrated in the video. We measured the drilling trajectories and compared it with pre-operative plan to evaluate distance of the pin insertion and angular deviations. Two orthopedic attendings expertly evaluated the participants’ performance using a modified global rating scale (GRS). There was a pre-video knowledge test that was repeated post-simulation alongside a Likert-scale questionnaire.ResultsThe angular deviation of the pin in EG was significantly less by 29% compared to CG (p = 0.037), with no significant difference in the entry point’s distance between groups (p = 0.204). The GRS scores for EG were 3.5% higher than CG (p = 0.046). There was a 32% higher overall knowledge test score (p<0.001) and 21% improved Likert-scale questionnaire score (p = 0.002) after video-learning in EG than CG, albeit no significant difference in the knowledge test score before video-learning (p = 0.721).ConclusionThe novel multiple POV provided significant objective and subjective advantages over single POV for acquisition of technical skills in hip surgery.

Six Sigma application for quality improvement of the pin insertion process

Six Sigma is a systematic and organized, client-oriented approach that aims to improve the performance and quality of processes, products and services using statistical techniques. This paper presents a case study performed in an automotive company that intends to reduce the defective units produced by an automatic process, the process of single pin insertion, using the DMAIC (Define, Measure, Analyze, Improve, Control) method that is a structured way to carried out Six Sigma projects. In this process, excessive pin insertion force on Printed Circuit Boards (PCBs) entailed high rejection costs and line stop times that affected the supply of the final assembly lines. Therefore, the application of Six Sigma had the purpose to increase the quantity of products produced well at the first time and to reduce the quality costs associated to the process. To this end, the problem was defined, measured and analyzed starting from the machine and the two products with the highest number of rejections. An exhaustive analysis to determine the root cause allowed concluding that the excessive force is generated by the interaction of three factors: the PCBs physical characteristics, the pins contact zone and the wear of the machine components. A set of improvements focused on these factors raised the quality levels of the process, making it more stable and with less variability, by reducing the insertion forces to values closer to the nominal value. Methods for keeping the process under control were also defined and implemented. The use of some quality tools and the Six Sigma methodology proved to be extremely positive since this has led to significant improvements in the quality of the pin insertion process.

Hardware/engineering battery-operated drills are more cost-effective as compared to orthopedic drills

Background: Drilling of the bone is common to produce holes for screws and pin insertion, to fix the fractured parts for immobilization. For this purpose, we need a power drill machine. Power drills used in orthopedic surgery can be categorized into two types: electrical and battery operated. Battery-operated drills could be orthopedic drills or hardware engineering drills. Commercial orthopedic battery drills (OBDs) are very costly. However, the same purpose can be subserved by hardware/engineering battery drill (HBD or EBD), with some additional practical advantages. Purpose: The purpose of this study is to aware the orthopedic surgeons who are working at resource constraint places about the advantages of EBD which is available at a very low price and serves the same purpose. Methods: We are using these battery operated hardware/engineering drills from quite a period of time and we have immense experiences with these EBD. The present article discusses in details about both the OBD and EBD. We assessed both drills by our own practical experience and compared both drills' specifications. Research Performance Place: The present study was conducted at Amandeep Hospital, G. T. Road, Model Town, Amritsar, Punjab, India. +91-98760-02746, 9876046778, E-mail: ah.admin@amandeephospital.org. It is a research institute with super specialty and multispecialty offering postgraduation courses and residency with national and international fellowships and observerships. Results: After comparing both the drills, we found that EBD is a very good substitute for OBD in orthopedic surgery in various aspects, namely availability, procurement, functionalities, servicing, and maintenance and is very cost-effective too. Conclusion: Hardware / engineering battery drills are very good and practical alternative to orthopedic drills in orthopedic surgeries. Hence, EBD is recommended for hospitals with limited resources and where treatment cost is an issue. Level of Evidence: 5.

Evaluation of Alternative Halo Ring Positions in Children Using Tomography

OBJECTIVES:The halo ring can be applied in children, through skeletal traction or a halo vest device, to treat many cervical spine pathologies, including traumatic injuries and pathologies related to deformities. However, the procedure is associated with various complications, such as infection, pin loosening, and respiratory and neurological problems. Although widely studied in adults, the best pin insertion site in children and the correlations of pin insertion sites with outcomes and complications have not been completely elucidated. This study aimed to determine alternative pin placement sites based on a morphological analysis of the infant skull by computerized tomography (CT).METHODS:An analytical-descriptive study was performed using 50 CT scans from children. The Wilcoxon and Friedman tests were used.RESULTS:A linear and directly proportional relation was found between cranial thickness and patient age. The average thicknesses of the anterior points across all ages analyzed ranged from 4.16 mm to 4.98 mm. The thicknesses of the posterior points varied from 3.94 mm to 4.27 mm. Within each age range, points 1 cm above the standard insertion sites had thicknesses similar to those of the standard sites, and points 2 cm above the standard insertion sites had thicknesses greater than those of the standard sites.CONCLUSIONS:The cranial thickness at all points increases linearly with age. Points 1 and 2 cm above the standard insertion sites are viable alternatives for the placement of halo pins. Preoperative CT can aid in choosing the best positioning sites for pins in the skull.

Dexmedetomidine Vs Fentanyl in Scalp Nerve Block for Blunting Response to Skull Pin Insertion and Post-operative Pain: A Randomized Double Blinded Study

Dexmedetomidine Vs Fentanyl in Scalp Nerve Block for Blunting Response to Skull Pin Insertion and Post-operative Pain: A Randomized Double Blinded Study

Safety of skeletal traction through the distal femur, proximal tibia, and calcaneus

Introduction: Skeletal traction provides pain relief and temporary stability in patients anticipating surgery for a variety of lower-extremity fractures. Recent literature suggests that distal femoral traction provides pain relief and is safe; however, data regarding proximal tibial and calcaneal pins are primarily historical and limited. The purpose of this study is to document complications associated with distal femur, proximal tibia, and calcaneal traction pin placement. Materials and Methods: We identified patients with the distal femur, proximal tibia, and calcaneal traction pin placement from January 2013 to June 2016. Chart review was utilized to identify any complications, including nerve or vascular injuries, need for revision, or infection. Results: Five hundred and nineteen traction pins were eligible for review, consisting of 120 calcaneal traction pins, 129 distal femoral pins, and 270 proximal tibia traction pins. Primary diagnosis was defined as 305 femur fractures (58.8%), 60 tibial shaft fractures (11.6%), 60 acetabular fractures (11.6%), 38 pilon fractures (7.3%), 30 pelvic ring injuries (5.8%), 21 tibial plateau fractures (4.0%), and 5 hip dislocations (1.0%). We identified 17 (3.3%) adverse events potentially attributable to traction pin insertion. Pins that became infected were found to have been in place for a significantly longer duration (18.3 days compared to 5.8 days, P = 0.0001). Conclusions: Traction pin placement for skeletal traction is generally an uncomplicated procedure. Duration of pin placement is significantly related to the likelihood of pin site infection.

Analgesia nociception index and hemodynamic changes during skull pin application for supratentorial craniotomies in patients receiving scalp block versus pin-site infiltration: A randomized controlled trial.

Background:Noxious stimulation such as skull pin insertion for craniotomy elicits a significant hemodynamic response. Both regional analgesic techniques (pin-site infiltration [PSI] and scalp block [SB]), and systemic strategies (opioids, alpha-2 agonists, anesthetics, and beta-blockers) have shown to attenuate this response. Analgesia Nociception Index (ANI) provides objective information about the magnitude of nociception and adequacy of analgesia. This study compared ANI and hemodynamic changes in patients receiving local anesthetic SB versus PSI during skull pin application for craniotomy.Materials and Methods:Sixty adult patients scheduled for elective supratentorial tumor surgery were randomly allocated to receive local anesthetic SB or PSI for skull pin insertion after the induction of anesthesia. Data regarding heart rate (HR), blood pressure (BP), and ANI were collected every minute for 5 min after the skull pin insertion beginning from the baseline.Results:A significant difference was observed in ANI values between the SB (higher ANI) and the PSI groups during skull pin insertion, P < 0.001 and P = 0.003 for ANIi and ANIm, respectively. Similarly, a significant difference was seen in HR and BP both within and between the two groups during skull pin insertion (P < 0.001 for both). The magnitude and duration of change were smaller in the SB group compared with the PSI group for the parameters studied. A strong negative linear correlation was noted between ANI and hemodynamic parameters.Conclusions:The changes in HR, BP, and ANI were significantly less with local anesthetic SB compared with PSI during skull pin insertion in patients undergoing supratentorial craniotomy.