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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.
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© 1992 Published by Elsevier Inc.
