top of page

Concentric Placement of Tibia Half Pins Reduces Risk of Stress Fractures With External Fixation

in People With Peripheral Neuropathy


Historically, surgeons have avoided using tibial half pins in circular external fixation for the fear of tibial stress fracture, a potentially devastating complication.


This is in spite of numerous studies demonstrating half pin ease of implementation, superior rigidity, and an overall risk of lower secondary complications, including superficial pin-site infection and loosening. The benefits of which are magnified when tibial half pins are combined with smooth Kirschner wires for circular external fixation.


Concentric versus eccentric half pin placement


In a first of its kind retrospective comparative study published in the Journal of Foot & Ankle Surgery, Wynes et al.assessed the incidence of tibia stress fracture was compared between patients who underwent bi-cortical placement of 6mm conical hydroxyapatite coated pins concentrically using a rancho-cube for “perfect circle” technique versus pins placed eccentrically. The pins were placed following placement of smooth Kirschner wires, and cortices of the tibia were avoided to lessen the incidence of stress fracture.


Overall, the rate of tibia stress fracture was significantly reduced to approximately 2% when the “perfect-circle” technique was used, compared to >18% when eccentric placement was performed.


The Takeaway


Perhaps tibial stress fractures with half pin placement have less to do with the pins themselves and more to do with intra-operative placement.

Recent Posts

See All

MIS Bunions

High on potential, grinding out market share, with research support slowly catching up. Burr-based osteotomy With ever-expanding options in the bunion market, the definition of MIS is a bit elusive. W

Back Together

Big Sky and AOFAS. The intimate setting of Big Sky, Montana hosted the AOFAS winter meeting last month. Designed as a smaller meeting in a family-friendly location this year featured massive amounts o

Poor Bone Quality Alert

DXA is a poor measure of extremity bone quality. Using indirect measures of bone quality like DXA is not an accurate way to predict bone quality for the foot and ankle surgeon. Outcomes parallel bone

Comentários


FIX Masthead 2000x318 v2.jpg
bottom of page