Hydroxyapatite-coated pins versus titanium alloy pins in external fixation at the wrist: a controlled cohort study.

Abstract

BACKGROUND:

The purpose of this study was to analyze whether the prevalence of pin-related complications can be reduced by the use of hydroxyapatite (HA)-coated pins in external fixators applied for unstable wrist fractures.

METHODS:

Forty patients (160 pins) were randomized for standard uniplanar fixator treatment with the use of identically designed pins either composed of titanium-alloy (Ti6Al4V) (n = 20) or coated by HA (n = 20). Each pin site was clinically evaluated with regard to erythema, drainage, pain value, and radiologically assessed concerning loosening at T1 (mean, 9 days), T2 (mean, 43 days), and T3 (mean, 56 days). In case of pin-track complication, the patient was followed continuously. The need for antibiotics or additional surgery was documented. Bone mineral density was analyzed by Dual Energy X-ray Absorptiometry. At fixator removal (T2), the pin-extraction strength was measured by the use of a digital-torque-wrench.

RESULTS:

Two minor pin-track infections requiring oral antibiotics occurred in the HA-pin group (2.7%) (p > 0.05). The vast majority of clinical pin-site parameters were comparable in both groups. At the end of the fixator therapy, there were 16 loose pins (n(Ti6AL4V-group) = 10; n(HA-group) = 6). The rate of loose pins was correlated to patient's age (p < 0.05) but not to bone mineral density values or the occurrence of pin-site infection. Finally, no significant difference between the two groups was detected with regard to the prevalence of clinical relevant pin-site complications (p = 0.80).

CONCLUSIONS:

In external fixation of the wrist, the use of HA-coated pins yields no clinical advantages: there is a trend toward a superior pin-bone anchorage, but a tendency of increased susceptibility for minor pin-track infections.

• Authors: Oliver Pieske, Leopold Pichlmaier, Felicitas Kaltenhauser, Nicolai Schramm, Bianka Rubenbauer, Axel Greiner, Stefan Piltz
• Journal: The Journal of trauma (J Trauma) Vol. 70 Issue 4 Pg. 845-51 (Apr 2011) ISSN: 1529-8809 [Electronic] United States
• PMID: 20805762 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial)

Chemical References

• Alloys
• Coated Materials, Biocompatible
• titanium aluminum alloy
• Durapatite

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Alloys
• Bone Nails
• Coated Materials, Biocompatible
• Durapatite
• Female
• Fracture Fixation (instrumentation)
• Fractures, Bone (diagnosis, surgery)
• Humans
• Male
• Middle Aged
• Prosthesis Design
• Treatment Outcome
• Wrist Injuries (diagnosis, surgery)
• Young Adult