The Effect of Insertion Technique on Temperatures for Standard and Self-Drilling External Fixation Pins.

OBJECTIVES: No studies have assessed the effects of parameters associated with insertion temperature in modern self-drilling external fixation pins. The current study assessed how varying the presence of irrigation, insertion speed, and force impacted the insertion temperatures of 2 types of standard and self-drilling external fixation half pins. METHODS: Seventy tests were conducted with 10 trials for 4 conditions on self-drilling pins, and 3 conditions for standard pins. Each test used a thermocouple inside the pin to measure temperature rise during insertion. RESULTS: Adding irrigation to the standard pin insertion significantly lowered the maximum temperature (P <0.001). Lowering the applied force for the standard pin did not have a significant change in temperature rise. Applying irrigation during the self-drilling pin tests dropped average rise in temperature from 151.3 ± 21.6°C to 124.1 ± 15.3°C (P = 0.005). When the self-drilling pin insertion was decreased considerably from 360 to 60 rpm, the temperature decreased significantly from 151.3 ± 21.6°C to 109.6 ± 14.0°C (P <0.001). When the force applied increased significantly, the corresponding self-drilling pin temperature increase was not significant. CONCLUSIONS: The standard pin had lower peak temperatures than the self-drilling pin for all conditions. Moreover, slowing down the insertion speed and adding irrigation helped mitigate the temperature increase of both pin types during insertion.

Locking Compression Pilon Plate for Fixation of Comminuted Posterior Wall Acetabular Fractures: A Novel Technique.

Posterior wall acetabular fractures involving a large portion the wall's width and with extensive comminution are difficult fractures to manage operatively. Cortical substitution with a pelvic reconstruction plate and supplemental spring plates has been the traditional means of fixation for these fractures. This option, however, requires the use of multiple, unlinked plates and provides no reliable option for peripheral fixation in comminuted fragments. We describe a novel technique for operative fixation of large, comminuted posterior wall fractures using a single distal tibia pilon plate with the option for peripheral locking screw fixation and report on a series of 20 consecutive patients treated with this method.

Measuring temperature rise during orthopaedic surgical procedures.

A reliable means for measuring temperatures generated during surgical procedures is needed to recommend best practices for inserting fixation devices and minimizing the risk of osteonecrosis. Twenty four screw tests for three surgical procedures were conducted using the four thermocouples in the bone and one thermocouple in the screw. The maximum temperature rise recorded from the thermocouple in the screw (92.7±8.9°C, 158.7±20.9°C, 204.4±35.2°C) was consistently higher than the average temperature rise recorded in the bone (31.8±9.3°C, 44.9±12.4°C, 77.3±12.7°C). The same overall trend between the temperatures that resulted from three screw insertion procedures was recorded with significant statistical analyses using either the thermocouple in the screw or the average of several in-bone thermocouples. Placing a single thermocouple in the bone was determined to have limitations in accurately comparing temperatures from different external fixation screw insertion procedures. Using the preferred measurement techniques, a standard screw with a predrilled hole was found to have the lowest maximum temperatures for the shortest duration compared to the other two insertion procedures. Future studies evaluating bone temperature increase need to use reliable temperature measurements for recommending best practices to surgeons.

Blocking wires facilitate freehand percutaneous plating of periarticular tibia fractures.

The authors describe the technique of blocking K-wires to facilitate the freehand percutaneous plating of periarticular tibia fractures. The blocking K-wires facilitate anatomic accuracy of plate placement, a limiting feature of percutaneous plating technique particularly in the absence of a plate-specific jig. The described technique is to be applied as part of a staged surgical protocol utilizing temporary external fixation and directed at the preservation of the periarticular soft-tissues of the tibia.

Host classification predicts infection after open fracture.

UNLABELLED: We propose that the classification commonly used in patients with osteomyelitis, the Gustilo classification, also is applicable to patients with open fractures as a method of identifying increased risk of infection because of comorbid medical illness. The records of 174 adult patients sustaining open fractures of long bones were retrospectively reviewed. Each patient was sorted into Class A, B, or C based on 14 immune system compromising factors. Class A has no compromising factors, Class B has one or two compromising factors, and Class C has more than three compromising factors. The association between class and infection was examined. The incidence of infection was 4%, 15%, and 30% in patients in Classes A, B, and C, respectively. Patients in Class B were 2.86 times more likely to have an infection, and patients in Class C were 5.72 times more likely to have an infection when both groups of patients were compared with patients in Class A. The Gustilo classification, location of fracture, and tobacco use are all factors associated with infection. Patients in Class B or C are at markedly increased risk of infection and may benefit from additional or alternative therapies that decrease the risk of infection. LEVEL OF EVIDENCE: Prognostic study, Level II-1 (retrospective study). See the Guidelines for Authors for a complete description of levels of evidence.

Temporary transarticular stabilization of a glenohumeral fracture dislocation: a technique revisited.

SUMMARY: A 93-year-old patient with an unstable fracture-dislocation of the glenohumeral joint and medical problems that precluded open surgery was first managed by an unsuccessful closed reduction. Temporary transarticular pin fixation then was used successfully, allowing the patient to return to early activities with minimal morbidity.