Advertisement
Research Article| Volume 23, SUPPLEMENT 3, S9-S27, 1992

4. Biomechanical evaluation of the Pinless external fixator

DOI:https://doi.org/10.1016/0020-1383(92)90004-C
4. Biomechanical evaluation of the Pinless external fixator
Previous Article3. The development of the Pinless external fixator: from the idea to the implant
Next Article5. Mechanical properties of the Pinless external fixator on human tibiae
      This paper is only available as a PDF. To read, Please Download here.

      Abstract

      In open fractures especially in those with severe soft tissue damage, fracture stabilisation is best achieved by using external fixators. There are some intrinsic complications which occur during classical external pin fixation. To overcome the problem of pin track infection and vascular damage from drilling, the Pinless external fixator was developed. It is based on the idea of a forceps with trocar points, which only penetrate the bone cortex superficially.
      The function of the device was tested in two mechanical trials and two in vitro tests in which one pinless clamp was put under a controlled load of 50 N, 150 cycles/day and studied over a 5 week period in sheep. The loads and time range of the experiment were chosen to simulate a temporary fracture stabilisation in a patient not bearing weight. The main question to be answered was whether the Pinless external fixator would be able to maintain stable fixation. Furthermore, it was to determine the changes at the trocar-to-bone interface.
      The clamp was found to maintain 72 % of the initially applied clamping force after 5 weeks of in vivo application and it was found to be tight at removal. Some decrease of clamping force was found during the first 20 days and then the force tended to level off. There was no slippage nor did the clamp penetrate the cortex. There were no obvious signs of infection around the trocar-holes and in the bacterial tests no pathological cultures were grown. Histology revealed very localised bone reactions, the indentation caused by the trocar tips being only 1.2 mm deep.
      The study concludes, as far as could be ascertained from these tests, that it is safe to use pinless external fixation for temporary fracture fixation.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Injury
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Register: Create an account
      Institutional Access: Sign in to ScienceDirect

      References

        • Aalto K
        • Slätis P
        • Karaju E
        • Waris P
        Pin-hole changes after external fixation of tubular bone.
        Arch. Orthop. Trauma Surg. 1984; 104: 118-120
        • Ahlers J
        • Ritter G
        • Weigand H
        Die Marknagelung als Sekundäreingriff nach vorausgegangener Anwendung des Fixateur externe.
        Unfallchir. 1983; 9: 83-91
        • Aho AJ
        • Niemen SJ
        • Nylamo EI
        External fixation by Hoffmann-Vidal-Adrey osteotaxis for severe tibial fractures.
        Clin. Orthop. 1983; 181: 154-164
        • Allerton KEG
        • Miles AE
        External fixation of tibial fractures at Groote Schuur Hospital, Cape Town.
        SA Med.Tydskrif. 1981; 26: 498-501
        • Bastiani G De
        • Aldegheri R
        • Brivio LR
        The treatment of fractures with a dynamic axial fixator.
        J. Bone Joint Surg. 1984; 66B: 538-545
        • Behrens F
        • Johnson WD
        • Koch TW
        • Kovacevic N
        Bending stiffness of unilateral and bilateral fixator frames.
        Clin. Orthop. 1983; 178: 103-110
        • Behrens F
        • Johnson W
        Unilateral external fixation. methods to increase and reduce frame stiffness.
        Clin. Orthop. 1989; 241: 48-56
        • Behrens F
        • Searls K
        External fixation of the tibia. basic concepts and prospective evaluation.
        J. Bone Joint Surg. 1986; 68B: 246-254
        • Behrens F
        General theory and principles of external fixation.
        Clin. Orthop. 1989; 241: 15-23
        • Benum P
        • Svenningsen S
        Tibial fractures treated with Hoffmann's external fixation.
        Acta Orthop. Scand. 1982; 53: 471-476
        • Billiouris TL
        • Schneider E
        • Rahn BA
        • Gasser B
        • Perren SM
        The effect of radial, preload on the implantbone interface: a cadaveric study.
        J. Orthop. Trauma. 1989; 3: 323-332
        • Blanchut PA
        • Meek RN
        • O'Brien PJ
        External fixation and delayed intramedullary nailing of open fractures of the tibial shaft. a sequential protocol.
        J. Bone Joint Surg. 1990; 72A: 729-735
        • Boltze WH
        Stabilitätsprüfung.
        AO-Bulletin. 1978;
        • Botte MJ
        • Garfin SR
        • Byrne TP
        • Woo S.L.-Y.
        • Nickel VL
        The Halo skeletal fixator. principles of application and maintenance.
        Clin. Orthop. 1989; 239: 12-18
        • Briggs BT
        • Chao EYS
        The mechanical performance of the standard Hoffmann-Vidal external fixation apparatus.
        J. Bone Joint. Surg. 1982; 64A: 566-573
        • Burny F
        • Bourgois R
        • Donkerwolkcke M
        Elastic external fixation: a biomechanical study of the half-frame.
        in: Concepts in external fixation. Grune & Stratton, 1982: 67-78
        • Cannon SR
        • Taylor AR
        • Lynch AR
        Simple external fixation of open and complicated fractures.
        Injury. 1985; 16: 367-370
        • Carter MD
        • Gilbert JA
        • Dahners LE
        An evaluation of the bending stiffness of various tibial fixation methods.
        Clin. Orthop. 1987; 224: 289-293
        • Chan KM
        • Leung YK
        • Cheng JCY
        • Leung PC
        The management of type III open tibial fractures.
        Injury. 1984; 16: 157-165
        • Chao EYS
        • Pope MH
        The mechanical basis of external fixation.
        in: Concepts in external fixation. Grune & Stratton, 1982: 13-39
        • Chao EYS
        • Kasman RA
        • An KN
        Rigidity and stress analyses of external fracture fixation devices — a theoretical approach.
        J. Biomec. 1982; 15: 971-983
        • Clifford RP
        • Lyons TJ
        • Webb JK
        Complications of external fixation of open fractures of the tibia.
        Injury. 1987; 18: 174-176
        • Court-Brown CM
        • Hughes SPF
        Hughes external fixator in treatment of tibial fractures.
        J. Royal Soc. Med. 1985; 78: 830-837
        • Edge AJ
        • Denham RA
        External Fixation for Complicated Tibial Fractures.
        J. Bone Joint Surg. 1981; 63B: 92-97
        • Edwards CC
        • Simmons SC
        • Browner BD
        • Weigel MC
        Severe open tibial fractures. results treating 202 injuries with external fixation.
        Clin. Orthop. 1988; 230: 98-115
        • Edwards CC
        Staged reconstruction of complex open tibial fractures using Hoffmann external fixation.
        Clin. Orthop. 1983; 178: 130-161
        • Etter C
        • Burri C
        • Claes L
        • Kinzl L
        • Raible M
        Treatment by external fixation of open fracture associated with severe soft tissue damage of the leg.
        Clin. Orthop. 1983; 178: 80-87
        • Evans M
        • Kenwright J
        • Tanner KE
        Analysis of single-sided external fracture fixation.
        Engineering Med. 1979; 8: 133-137
        • Fellander M
        Treatment of fractures and pseudarthrosis of the long bone by Hoffmann's transfixation method (osteotaxis).
        Acta Othop. Scand. 1963; 32: 132-150
        • Finlay JL
        • Eng P
        • Moroz TK
        • Rorabeck CH
        • Davey JR
        • Bourne RB
        Stability of ten configurations of the Hoffmann external fixation frame.
        J. Bone Joint Surg. 1987; 69A: 734-744

      31. Ganz R (1990) Pers. com.

        • Ganz R
        • Perren SM
        • Rüter A
        Mechanical induction of bone resorption.
        Fortschr. Kiefer.-Gesichtschir. 1975; 19: 45-48
        • Garfin SR
        • Botte MJ
        • Waters RL
        • Nickel VL
        Complications in the use of the Halo fixation device.
        J. Bone Joint Surg. 1986; 68A: 320-325
        • Gasser B
        Radialspannung in Knochengewebe, welches Steinemann-Nägel resp.
        Schanz'sche Schrauben umgibt. Internal Report. 1984;
        • Genelin F
        • Obrist J
        • Trost A
        • Kröpfl
        Kritische Analyse von 42 primär mit Fixateur externe behandelten Unterschenkel.
        Unfallchirurgische Vers. und Berufsmittel. 1988; 91: 87-91
        • Gershuni DH
        • Halma G
        The AO external skeletal fixator in the treatment of severe tibial fractures.
        J. Trauma. 1983; 23: 986-990
        • Goodship A
        • Kenwright J
        The influence of induced micromovement upon healing of experimental tibial fractures.
        J. Bone Joint Surg. 1985; 67B: 650-655
        • Green SA
        • Ripley MJ
        Chronic osteomyelitis in pin tracks.
        J. Bone Joint Surg. 1984; 66A: 1092-1098
        • Green SA
        Complications of external fixation.
        in: current concepts of external fixation of fractures. Springer Verlag, Heidelberg1982: 43
        • Green SA
        Complications of external skeletal fixation.
        Charles C.Thomas, Springfield, Illinois, USA1981
        • Gustilo RR
        • Anderson JT
        Prevention of infection in the treatment of one-thousand and twenty.five open fractures of long bones.
        J. Bone Joint Surg. 1976; 58A: 453-458
        • Hammer R
        External fixation of tibial shaft fractures. a review of 42 fractures treated by the Hoffman-Vidal-Adrey external fixation system.
        Arch. Orthop. Trauma Surg. 1985; 104: 271-274
        • Hax P-M
        • Hierholzer G
        Experimentelle Untersuchungen der Stabilität verschiedener Montageformen des unilateralen Fixateur externe.
        Unfallheilkunde. 1986; 181: 52-62
        • Heiser TM
        • Jacobs RR
        Complicated extremity fractures. The relation between external fixation and nonunion.
        Clin. Orthop. 1983; 178: 89-95
        • Hierholzer G
        • Kleining R
        Theoretische Grundlagen und Biomechanik der Fixateur externe Osteosynthese.
        in: Langenbecks Archiv für Chirurgie. 358. Springer Verlag, 1982: 105-112
        • Huiskes R
        • Chao EYS
        Guidelines for external fixation frame rigidity and stresses.
        J. Orthop. Res. 1986; 4: 68-75
        • Huiskes R
        • Chao EYS
        • Crippen TE
        Parametric analyses of pin-bone stresses in external fracture fixation devices.
        J. Orthop. Res. 1985; 3: 341-349
        • Hyldahl C
        • Pearson S
        • Tepic S
        • Perren SM
        Induction and prevention of pin loosening in external fixation: an in vivo study on sheep tibiae.
        J Orthop. Trauma. 1991; 5: 485-492
        • Johnson EE
        • Simpson LA
        • Helfet DL
        Delayed intramedullary nailing after failed external fixation of the tibia.
        Clin. Orthop. 1990; 253: 251-257
        • Karlstroem G
        • Olerud S
        Fractures of the tibial shaft. A critical evaluation of treatment alternatives.
        Clin. Orthop. 1974; 105: 82-115
        • Karlstroem G
        • Olerud S
        External fixation of severe open tibial fractures with the Hoffmann frame.
        Clin. Orthop. 1983; 180: 68-78
        • Karlstroem G
        • Olerud S
        Percutaneous pin fixation of open tibial fractures.
        J. Bone Joint Surg. 1975; 56B: 915-924
        • Kenwright J
        • Goodship AE
        Controlled mechanical stimulation in the treatment of tibial fractures.
        Clin. Orthop. 1989; 241: 36-47
        • Kenwright J
        • et al.
        Effect of controlled axial micromovement on healing of tibial fractures.
        Lancet. 1986; 22: 36-47
        • Kimmel RB
        Results of treatment using the Hoffmann external fixator for fractures of the tibial diaphysis.
        J. Trauma. 1982; 22: 960-965
        • Krempen JF
        • Silver RA
        • Sotelo A
        The use of the Vidal-Adrey external fixation system. Part 2: The treatment of infected and previously infected pseudarthroses.
        Clin. Orthop. 1979; 140: 122-130
        • Krempen JF
        • Silver RA
        • Sotelo A
        The use of the Vidal-Adrey external fixation system. Part 1: The treatment of open fractures.
        Clin. Orthop. 1979; 140: 111-121
        • Krezel T
        Vorrichtung zum Aneinanderdrücken der Bruchstellen bei Oberschenkelhalsfrakturen.
        1960 (Oesterreichisches Patentamt. Patent no. 210985)
        • Larsson K
        • van der Linden W
        Open tibial shaft fractures.
        Clin. Orthop. 1983; 180: 63-67
        • Lawyer RB
        • Lubbers LM
        Use of Hoffmann apparatus in the treatment of unstable tibial fractures.
        J. Bone Joint Surg. 1980; 62A: 1264-1273
        • Lindahl O
        Rigidity of immobilization of oblique fractures.
        Acta Orthop. Scand. 1964; 35: 39-50
        • Matthews LS
        • Green CA
        • Goldstein SA
        • Arbor A
        The thermal effects of skeletal fixation — pin insertion in bone.
        J. Bone Joint Surg. 1984; 66A: 1077-1083
        • Maurer DJ
        • Merkow RL
        • Gustilo RB
        Infection after intramedullary nailing of severe open tibial fractures initially treated with external fixation.
        J. Bone Joint Surg. 1989; 71A: 835-838
        • McCoy MT
        • Chao EYS
        • Kasman RA
        Comparison of mechanical performance in four types of external fixators.
        Clin. Orthop. 1983; 180: 23-33
        • McGraw JM
        • Lim EVA
        Treatment of open tibial shaft fractures. External fixation and secondary intramedullary nailing.
        J. Bone Joint Surg. 1988; 70A: 900-911
        • Mendes JE
        • Cabral AT
        • Lima C
        Open fractures of the tibia.
        Clin. Orthop. 1981; 156: 98-104
        • Mennen U
        The use of a clamp-on plate for forearm fractures.
        Orthopedics. 1989; 12: 39-43
        • Mooney V
        • Claudi B
        How stable should external fixation be?.
        in: Current concepts of external fixation of fractures. Springer Verlag, Heidelberg1982: 21-26
        • Moroz TK
        • Finlay JB
        • Rorabeck CH
        • Bourne RB
        External fixation: Choosing a system based on biomechanical stability.
        J. Orthop. Trauma. 1989; 2: 284-296
        • Müller ME
        • Allgöwer M
        • Schneider R
        • Willenegger H
        Manual of internal fixation. Springer Verlag, 1991: 367
        • Naden JR
        External skeletal fixation in the treatment of fractures of the tibia.
        J. Bone Joint Surg. 1949; 31A: 586-598
        • Nesbakken A
        • et al.
        Open tibial fractures treated with Hoffmann external fixation.
        Arch. Orthop. Trauma Surg. 1988; 107: 248-252
        • Nickel VL
        • Perry J
        • Garret A
        • Heppenstall M
        The Halo. A spinal skeletal traction fixation device.
        Clin. Orthop. 1989; 239: 4-11
        • Perren SM
        • et al.
        Cortical bone healing.
        in: Acta Orthop. Scand. Suppl. 125. Munksgaard, Copenhagen1969
        • Perren SM
        • Ganz R
        • Rueter A
        Oberflächliche Knochenresorption um Implantate.
        Med.-Orthop. Technik. 1975; 1: 6-10
        • Perren SM
        Basic aspects and scientific background of internal fixation.
        AO-Bulletin. 1989;
        • Pincock DF
        Surgical Pin Guide. 1948; (United States Patent Office, 2434431)
        • Puno RM
        • Teynor JT
        • Nagano J
        • Gustilo RB
        Critical analysis of results of treatment of 201 tibial shaft fractures.
        Clin. Orthop. 1986; 212: 113-121
        • Reith H.-B.
        • Böddeker W
        • Pelzer C
        • Kozuschek W
        “Ring Fixator” for treatment of lower leg fractures. A review of 30 cases treated by a new external fixation system.
        Int. Surg. 1988; 73: 170-172
        • Rommens P
        • Schmit-Neuerburg KP
        Ten years of experience with the operative management of tibial shaft fractures.
        J. Trauma. 1987; 27: 917-927
        • Rommens P
        • Broos P
        • Gruwez JA
        External fixation of tibial shaft fractures with severe soft tissue injuries by Hoffmann-Vidal-Adrey osteotaxis.
        Arch. Orthop. Trauma Surg. 1986; 105: 170-174
        • Rommens P
        • Gielen P
        • Broos P
        • Gruwez J
        Intrinsic problems with the external fixation device of Hoffmann-Vidal-Adrey: A critical evaluation of 117 patients with complex tibial shaft fractures.
        J. Trauma. 1989; 29: 630-638
        • Rusanen M
        • Karahaju E
        • Korkala O
        The halo brace in unstable fractures of the cervical spine: a review of 14 cases.
        Injury. 1985; 16: 318-320
        • Schmidt A
        • Rorabeck CH
        Fractures of the tibia treated by flexible external fixation.
        Clin. Orthop. 1983; 178: 162-172
        • Sedlin ED
        A rheologic model for cortical bone.
        in: Acta Orthop. Scand. Suppl. 83. Munksgaard, Copenhagen1965
        • Sharf W
        • Orthner E
        • Wagner M
        Behandlungsrichtlinien and Ergebnisse schwerst offener Unterschenkelbrüche.
        Unfallchirurg. 1984; 10: 192-299
        • Sisk DT
        External fixation. Historic review, advantages, disadvantages, complications, and indications.
        Clin. Orthop. 1983; 180: 15-22
        • Stadler J
        • Brennwald J
        • Frigg R
        • Perren SM
        Induction of bone surface resorption by motion. An in vivo study using passive and active implants.
        in: At Sec. Int. Symp. on Int. Fix. of Fract, Lyon 16.–18.Sept.1982: 62-64
        • Törnqvist H
        Tibia nonunions treated by interlocked nailing: increased risk of infection after previous external fixation.
        J. Orthop. Trauma. 1990; 4: 109-114
        • Velazco A
        • Fleming LL
        Open fractures of the tibia treated by the Hoffmann external fixator.
        Clin. Orthop. 1983; 180: 125-132
        • Vidal J
        External fixation. Yesterday, today and tomorrow.
        Clin. Orthop. 1983; 180: 7-14
        • Vidal J
        • Buscayret C
        • Connes H
        • Melka J
        • Orst G
        Guidelines for the treatment of open fractures and infected pseudarthroses by external fixation.
        Clin. Orthop. 1983; 180: 83-95
        • Wolter D
        • Reimann B
        Möglichkeiten und Grenzen der Therapie von Halswirbelverletzungen mit dem Halo-Fixator.
        Unfallchirurgie. 1989; 15: 83-94

      Article info

      Identification

      DOI: https://doi.org/10.1016/0020-1383(92)90004-C

      Copyright

      © 1992 Published by Elsevier Inc.

      ScienceDirect

      Access this article on ScienceDirect
      We use cookies to help provide and enhance our service and tailor content. To update your cookie settings, please visit the for this site.
      Copyright © 2023 Elsevier Inc. except certain content provided by third parties. The content on this site is intended for healthcare professionals.


      RELX