BACKGROUND Infection at the pin tract is a frequent and feared complication of external fixators(EF).The type of pin material and coatings have been regarded as possibly influencing infection rates.Over the last 20 ye...BACKGROUND Infection at the pin tract is a frequent and feared complication of external fixators(EF).The type of pin material and coatings have been regarded as possibly influencing infection rates.Over the last 20 years,few prospective clinical studies and systematic reviews addressed the role of coated pins on the rate of pin site infection in human clinical studies.AIM To assess the EF literature over the past 20 years on the clinical benefits of pins manufactured from varied materials and coating systems and their possible role in pin tract infection rates.METHODS We performed a systematic review according to the PRISMA and PICOS guidelines using four scientific platforms:PubMed,LiLacs,SciELO,and Cochrane.We searched the literature for related publications over the past 20 years.RESULTS A literature search yielded 29 articles,among which seven met the inclusion criteria.These studies compared stainless-steel pins and pins coated with hydroxyapatite(HA),titanium and silver.The pin tract infection definitions were arbitrary and not standardized among studies.Most studies included a low number of patients in the analysis and used a short follow-up time.Three metaanalyses were carried out,comparing stainless steel vs silver pins,stainless steel vs HA-coated pins,and titanium vs HA-coated pins.None of this analysis resulted in statistically significant differences in pin tract infection rates.CONCLUSION Currently,no clinical evidence supports the advantage of EF pins manufactured with materials other than stainless steel or coated over uncoated pins in reducing the rates of pin tract infections.A standardized definition of pin tract infection in external fixation is still lacking.展开更多
This work investigates the impact of biomechanical wear and abrasion on the antibiotic release profiles of hydroxyapatite (HA) coated fixation pins during their insertion into synthetic bone. Stainless steel fixation ...This work investigates the impact of biomechanical wear and abrasion on the antibiotic release profiles of hydroxyapatite (HA) coated fixation pins during their insertion into synthetic bone. Stainless steel fixation pins are coated with crystalline TiO2 by cathodic arc evaporation forming the bioactive layer for biomimetic deposition of Tobramycin containing HA. Tobramycin is either introduced by co-precipitation during HA formation or by adsorption-loading after HA deposition. The samples containing antibiotics are inserted into bone mimicking polyethylene foam after which the drug release is monitored using high performance liquid chromatography. This analysis shows that HA coating wear and delamination significantly decrease the amount of drug released during initial burst, but only marginally influence the sustained release period. Spalled coating fragments are found to remain within the synthetic bone material structure. The presence of HA within this structure supports the assumption that the local release of Tobramycin is not only expected to eliminate bacteria growth directly at the pin interface but as well at some distance from the implant. Furthermore, no negative effect of gamma sterilization could be observed on the drug release profile. Overall, the observed results demonstrate the feasibility of a multifunctional implant coating that is simultaneously able to locally deliver clinically relevant doses of antibiotics and an HA coating capable of promoting osteoconduction. This is a potentially promising step toward orthopaedic devices that combine good fixation with the ability to treat and prevent post-surgical infections.展开更多
To evaluate the clinical significance of Baumann’s angle in the closed reduction and percutaneous pinning fixation for supracondylar fractures of the humerus in children.Methods There were 97 children (male 59,female...To evaluate the clinical significance of Baumann’s angle in the closed reduction and percutaneous pinning fixation for supracondylar fractures of the humerus in children.Methods There were 97 children (male 59,female 38,mean age of 6.8 years) with displaced supracondylar fracrtures of the humerus were treated in this hospital.Under fluoroscopy guidance,three-dimensional displacement of fractures was corrected by closed reduction.The percutaneous Kirschner wire pinning was applied only if the radiographs demonstrated that Baumann’s angle was less than 4 degree compared to that on the normal side.All of them were followed up for 34.5 months (range,12 to 48 months).Results There was one case with ulnar nerve palsy associated with the pinning.There were no Volkmann’s contracture in this group.X-ray examinations revealed an average 73.7 degrees of Baumann angle on the injured and 72.8 on uninjured side.An average 7.6 degrees of the carrying angle on the injured and 9.7 on uninjured side were also demonstrated by radiography.Five patients developed slight cubitus varus deformity.The result according to Flynn criteria were excellent in 85 patients (87.6%),good in 12 patients (12.4%).Conclusion The satisfactory results can be gained in children with displaced supracondylar fractures of the humerus by restoration of the normal Baumann angle and percutaneous pinning fixation.18 refs,2 figs.展开更多
BACKGROUND Neonatal distal humeral physeal fractures are rare and difficult to diagnose.Thus,missed diagnoses and delayed healing are possible.Few studies have reported surgical treatment,because a callus may develop ...BACKGROUND Neonatal distal humeral physeal fractures are rare and difficult to diagnose.Thus,missed diagnoses and delayed healing are possible.Few studies have reported surgical treatment,because a callus may develop at the fracture site 5 d after the fracture,resulting in difficult reduction,and reduction of the limb may cause further physeal injury.Other surgical challenges include the provision of adequate anesthesia and complexity of the operation.However,without appropriate reduction and fixation,a varus elbow deformity may develop.Manual reduction and percutaneous pin fixation are ideal treatment options.CASE SUMMARY A 4-day-old neonate with left elbow pain accompanied by limited movement for 4 d was admitted,and diagnosed with delayed physeal fracture of the distal humerus based on physical examination,ultrasonography,and magnetic resonance imaging.The patient was treated by manual reduction combined with percutaneous pin fixation under arthrography.Postoperatively,the reduction was successful.The upper limbs could have been lifted and the fingers could have been moved freely on the second day after the operation.CONCLUSION The techniques of manual reduction and percutaneous pin fixation,to treat neonatal distal humeral physeal fractures,are safe and reliable.展开更多
Background: Pediatric supracondylar humerus fractures are the most common elbow fractures in children. Operative management includes closed reduction and placement of 2 to 3 laterally based pins. Occasionally, a media...Background: Pediatric supracondylar humerus fractures are the most common elbow fractures in children. Operative management includes closed reduction and placement of 2 to 3 laterally based pins. Occasionally, a medial pin is used to create a crossed fixation pattern, despite risk of nearly 10% iatrogenic ulnar nerve injury. The objective of this study was to assess the trends and outcomes in the operative management of pediatric supracondylar humerus fractures at a level one academic trauma center. Materials & Methods: A retrospective review was performed on all children sustaining a Gartland type II or III supracondylar humerus fractures treated by closed or open reduction and percutaneous pinning in 2006-2008 and 2009-2011 at a level one academic trauma center by two of the authors (JTR, LMT). Pin placement patterns were evaluated and compared based on year performed. Outcomes measured were rates of ulnar nerve symptoms, non-union, re-operation, and varus malalignment. Data analysis was performed using a Fisher exact test on STATA software. Results: A total of 49 patients met inclusion criteria. Of 22 patients treated in 2006-2008, 5 (23%) were type II and 17 (77%) were type III. From 2009-2011, 16 (59%) were type II and 11 (41%) were type III. Comparison of pinning pattern in type II fractures between 2006-2008 and 2009-2011 did not indicate statistical significance (p = 0.429). Comparison of pinning pattern in type III fractures during the same time period did show that there was a statistically significant decrease (p = 0.010) in the number of cross pin fixations. There were no ulnar nerve injuries, non-unions, re-operations, or varus malalignment in any patient on final follow-up. Conclusion: This study shows that there has been a significant decrease in cross pin fixation for pediatric type III supracondylar humerus fractures with equivalent clinical outcomes at a Level I trauma center. Furthermore, performing lateral pinning for type III fractures has eliminated the risk of iatrogenic ulnar nerve injury. Level of Evidence: Level III—Retrospective cohort study.展开更多
背景对于移位明显的儿童肱骨外髁骨折,传统治疗方法为切开复位后内固定治疗,但近年来采用闭合复位后克氏针固定治疗儿童肱骨外髁骨折的报道渐多,但究竟哪种手术方式的疗效与安全性更高,存在一定的争议。目的对闭合复位经皮穿针(CRPP)、...背景对于移位明显的儿童肱骨外髁骨折,传统治疗方法为切开复位后内固定治疗,但近年来采用闭合复位后克氏针固定治疗儿童肱骨外髁骨折的报道渐多,但究竟哪种手术方式的疗效与安全性更高,存在一定的争议。目的对闭合复位经皮穿针(CRPP)、切开复位克氏针内固定(ORKF)在小儿肱骨外髁骨折中的应用效果及安全性进行评价。方法计算机检索包括中国知网、万方数据知识服务平台、维普网、中国生物医学文献数据库、PubMed、Embase、Cochrane Library和Web of Science在内的中文和英文数据库,检索时间为各数据库建立至2023-01-01。筛选两种手术方法治疗小儿肱骨外髁骨折的病例对照研究后,对其进行文献质量评价并提取数据。运用RevMan 5.3软件进行Meta分析,对两种手术方式的相关疗效及安全性指标进行比较。结果共纳入16篇文献进行Meta分析,包括1165例患儿。Meta分析结果显示,CRPP组患儿手术时间短于ORKF组(MD=-11.81,95%CI=-15.04~-8.58,P<0.00001),术中出血量低于ORKF组(MD=-3.36,95%CI=-4.37~-2.36,P<0.00001),术后骨折愈合时间短于ORKF组(MD=-3.92,95%CI=-6.80~-1.03,P=0.008),克氏针存留时间短于ORKF组(MD=-3.35,95%CI=-6.33~-0.38,P=0.03),术后肘关节功能恢复不良率低于ORKF组(OR=0.44,95%CI=0.25~0.76,P=0.006),术后总体并发症的发生率低于ORKF组(OR=0.33,95%CI=0.19~0.56,P<0.0001),浅表感染的发生率低于ORKF组(OR=0.39,95%CI=0.21~0.73,P=0.003);而两组深部感染、不良愈合、肱骨外髁缺血坏死发生率比较,差异无统计学意义(P>0.05)。结论CRPP治疗儿童肱骨外髁骨折,无论从效果还是从整体并发症上均优于ORKF,但在具体并发症方面尚需更多高质量文献进一步验证。展开更多
文摘BACKGROUND Infection at the pin tract is a frequent and feared complication of external fixators(EF).The type of pin material and coatings have been regarded as possibly influencing infection rates.Over the last 20 years,few prospective clinical studies and systematic reviews addressed the role of coated pins on the rate of pin site infection in human clinical studies.AIM To assess the EF literature over the past 20 years on the clinical benefits of pins manufactured from varied materials and coating systems and their possible role in pin tract infection rates.METHODS We performed a systematic review according to the PRISMA and PICOS guidelines using four scientific platforms:PubMed,LiLacs,SciELO,and Cochrane.We searched the literature for related publications over the past 20 years.RESULTS A literature search yielded 29 articles,among which seven met the inclusion criteria.These studies compared stainless-steel pins and pins coated with hydroxyapatite(HA),titanium and silver.The pin tract infection definitions were arbitrary and not standardized among studies.Most studies included a low number of patients in the analysis and used a short follow-up time.Three metaanalyses were carried out,comparing stainless steel vs silver pins,stainless steel vs HA-coated pins,and titanium vs HA-coated pins.None of this analysis resulted in statistically significant differences in pin tract infection rates.CONCLUSION Currently,no clinical evidence supports the advantage of EF pins manufactured with materials other than stainless steel or coated over uncoated pins in reducing the rates of pin tract infections.A standardized definition of pin tract infection in external fixation is still lacking.
文摘This work investigates the impact of biomechanical wear and abrasion on the antibiotic release profiles of hydroxyapatite (HA) coated fixation pins during their insertion into synthetic bone. Stainless steel fixation pins are coated with crystalline TiO2 by cathodic arc evaporation forming the bioactive layer for biomimetic deposition of Tobramycin containing HA. Tobramycin is either introduced by co-precipitation during HA formation or by adsorption-loading after HA deposition. The samples containing antibiotics are inserted into bone mimicking polyethylene foam after which the drug release is monitored using high performance liquid chromatography. This analysis shows that HA coating wear and delamination significantly decrease the amount of drug released during initial burst, but only marginally influence the sustained release period. Spalled coating fragments are found to remain within the synthetic bone material structure. The presence of HA within this structure supports the assumption that the local release of Tobramycin is not only expected to eliminate bacteria growth directly at the pin interface but as well at some distance from the implant. Furthermore, no negative effect of gamma sterilization could be observed on the drug release profile. Overall, the observed results demonstrate the feasibility of a multifunctional implant coating that is simultaneously able to locally deliver clinically relevant doses of antibiotics and an HA coating capable of promoting osteoconduction. This is a potentially promising step toward orthopaedic devices that combine good fixation with the ability to treat and prevent post-surgical infections.
文摘To evaluate the clinical significance of Baumann’s angle in the closed reduction and percutaneous pinning fixation for supracondylar fractures of the humerus in children.Methods There were 97 children (male 59,female 38,mean age of 6.8 years) with displaced supracondylar fracrtures of the humerus were treated in this hospital.Under fluoroscopy guidance,three-dimensional displacement of fractures was corrected by closed reduction.The percutaneous Kirschner wire pinning was applied only if the radiographs demonstrated that Baumann’s angle was less than 4 degree compared to that on the normal side.All of them were followed up for 34.5 months (range,12 to 48 months).Results There was one case with ulnar nerve palsy associated with the pinning.There were no Volkmann’s contracture in this group.X-ray examinations revealed an average 73.7 degrees of Baumann angle on the injured and 72.8 on uninjured side.An average 7.6 degrees of the carrying angle on the injured and 9.7 on uninjured side were also demonstrated by radiography.Five patients developed slight cubitus varus deformity.The result according to Flynn criteria were excellent in 85 patients (87.6%),good in 12 patients (12.4%).Conclusion The satisfactory results can be gained in children with displaced supracondylar fractures of the humerus by restoration of the normal Baumann angle and percutaneous pinning fixation.18 refs,2 figs.
文摘BACKGROUND Neonatal distal humeral physeal fractures are rare and difficult to diagnose.Thus,missed diagnoses and delayed healing are possible.Few studies have reported surgical treatment,because a callus may develop at the fracture site 5 d after the fracture,resulting in difficult reduction,and reduction of the limb may cause further physeal injury.Other surgical challenges include the provision of adequate anesthesia and complexity of the operation.However,without appropriate reduction and fixation,a varus elbow deformity may develop.Manual reduction and percutaneous pin fixation are ideal treatment options.CASE SUMMARY A 4-day-old neonate with left elbow pain accompanied by limited movement for 4 d was admitted,and diagnosed with delayed physeal fracture of the distal humerus based on physical examination,ultrasonography,and magnetic resonance imaging.The patient was treated by manual reduction combined with percutaneous pin fixation under arthrography.Postoperatively,the reduction was successful.The upper limbs could have been lifted and the fingers could have been moved freely on the second day after the operation.CONCLUSION The techniques of manual reduction and percutaneous pin fixation,to treat neonatal distal humeral physeal fractures,are safe and reliable.
文摘Background: Pediatric supracondylar humerus fractures are the most common elbow fractures in children. Operative management includes closed reduction and placement of 2 to 3 laterally based pins. Occasionally, a medial pin is used to create a crossed fixation pattern, despite risk of nearly 10% iatrogenic ulnar nerve injury. The objective of this study was to assess the trends and outcomes in the operative management of pediatric supracondylar humerus fractures at a level one academic trauma center. Materials & Methods: A retrospective review was performed on all children sustaining a Gartland type II or III supracondylar humerus fractures treated by closed or open reduction and percutaneous pinning in 2006-2008 and 2009-2011 at a level one academic trauma center by two of the authors (JTR, LMT). Pin placement patterns were evaluated and compared based on year performed. Outcomes measured were rates of ulnar nerve symptoms, non-union, re-operation, and varus malalignment. Data analysis was performed using a Fisher exact test on STATA software. Results: A total of 49 patients met inclusion criteria. Of 22 patients treated in 2006-2008, 5 (23%) were type II and 17 (77%) were type III. From 2009-2011, 16 (59%) were type II and 11 (41%) were type III. Comparison of pinning pattern in type II fractures between 2006-2008 and 2009-2011 did not indicate statistical significance (p = 0.429). Comparison of pinning pattern in type III fractures during the same time period did show that there was a statistically significant decrease (p = 0.010) in the number of cross pin fixations. There were no ulnar nerve injuries, non-unions, re-operations, or varus malalignment in any patient on final follow-up. Conclusion: This study shows that there has been a significant decrease in cross pin fixation for pediatric type III supracondylar humerus fractures with equivalent clinical outcomes at a Level I trauma center. Furthermore, performing lateral pinning for type III fractures has eliminated the risk of iatrogenic ulnar nerve injury. Level of Evidence: Level III—Retrospective cohort study.
文摘背景对于移位明显的儿童肱骨外髁骨折,传统治疗方法为切开复位后内固定治疗,但近年来采用闭合复位后克氏针固定治疗儿童肱骨外髁骨折的报道渐多,但究竟哪种手术方式的疗效与安全性更高,存在一定的争议。目的对闭合复位经皮穿针(CRPP)、切开复位克氏针内固定(ORKF)在小儿肱骨外髁骨折中的应用效果及安全性进行评价。方法计算机检索包括中国知网、万方数据知识服务平台、维普网、中国生物医学文献数据库、PubMed、Embase、Cochrane Library和Web of Science在内的中文和英文数据库,检索时间为各数据库建立至2023-01-01。筛选两种手术方法治疗小儿肱骨外髁骨折的病例对照研究后,对其进行文献质量评价并提取数据。运用RevMan 5.3软件进行Meta分析,对两种手术方式的相关疗效及安全性指标进行比较。结果共纳入16篇文献进行Meta分析,包括1165例患儿。Meta分析结果显示,CRPP组患儿手术时间短于ORKF组(MD=-11.81,95%CI=-15.04~-8.58,P<0.00001),术中出血量低于ORKF组(MD=-3.36,95%CI=-4.37~-2.36,P<0.00001),术后骨折愈合时间短于ORKF组(MD=-3.92,95%CI=-6.80~-1.03,P=0.008),克氏针存留时间短于ORKF组(MD=-3.35,95%CI=-6.33~-0.38,P=0.03),术后肘关节功能恢复不良率低于ORKF组(OR=0.44,95%CI=0.25~0.76,P=0.006),术后总体并发症的发生率低于ORKF组(OR=0.33,95%CI=0.19~0.56,P<0.0001),浅表感染的发生率低于ORKF组(OR=0.39,95%CI=0.21~0.73,P=0.003);而两组深部感染、不良愈合、肱骨外髁缺血坏死发生率比较,差异无统计学意义(P>0.05)。结论CRPP治疗儿童肱骨外髁骨折,无论从效果还是从整体并发症上均优于ORKF,但在具体并发症方面尚需更多高质量文献进一步验证。