|Year : 2016 | Volume
| Issue : 1 | Page : 6-16
A systematic review of incidence of pin track infections associated with external fixation
Christopher A Iobst1, Raymond W Liu2
1 Department of Orthopedic Surgery, Nemours Children's Hospital, Orlando, FL 32827, USA
2 Department of Orthopaedic Surgery, Rainbow Babies and Children's Hospital, RBC 6081, Cleveland, OH 44106, USA
|Date of Submission||12-Jan-2016|
|Date of Acceptance||12-Apr-2016|
|Date of Web Publication||17-May-2016|
Christopher A Iobst
Nemours Children's Hospital, 13535 Nemours Parkway, Orlando, FL 32827
Source of Support: None, Conflict of Interest: None
Depending on the reference, pin track infection rates in external fixation surgery have been stated to be anywhere from 0% to 100%. We critically evaluated the pin track infection rate for external fixation by performing systematic review of the external fixation literature since 1980. Using PubMed, a search of the peer-reviewed literature on external fixation was performed. This systematic review was conducted, as much as possible, in accordance with PICOS and PRISMA guidelines. A total of 150 articles were reviewed, including at least one from each year between 1980 and 2014. The following data were collected from each article: the year of publication, number of patients in the study, average age of the patients, reason for the external fixation, fixation per segment (two or more than two points), body part involved, whether or not hydroxyapatite-coated pins were used, duration of the external fixator, type of fixator used, and number of patients with documented pin track infections. These 150 studies represented 6130 patients. There were 1684 reported pin track infections from these 6130 patients, giving a cumulative pin track infection rate of 27.4%. A more recent year of publication was associated with an increasing infection rate (P = 0.015) while increasing age was associated with a decreased infection rate (P < 0.0005). There were trends toward association of humerus location (P = 0.059), shorter fixator duration (P = 0.056), and circular fixation (P = 0.079) with decreased infection rates. This systematic review of external fixation publications revealed a cumulative pin track infection rate of 27%. Younger age was the factor leading to increased pin track infection rates. Circular fixation trended toward being protective of pin track infection when usage was factored into the multiple regression analysis. Longer duration of fixation trended toward increased infection rate as expected. This data provides important base values for a common complication in external fixation treatment, highlights the importance of a more consistent definition of a pin track infection in future research, and identifies the pediatric population as the group at greatest risk.
Keywords: External fixator, Ilizarov, pin track infection
Key Message: Based on the published data in 150 studies involving 6130 patients undergoing external fixation since 1980, the cumulative pin track infection rate was 27%.
|How to cite this article:|
Iobst CA, Liu RW. A systematic review of incidence of pin track infections associated with external fixation. J Limb Lengthen Reconstr 2016;2:6-16
| Introduction|| |
The health and stability of the half pin to skin interface and the half pin to bone interface are critical in external fixation. Breakdown at either of these interfaces can result in a pin track infection. Despite innovations in half pin design and pin care regimens, pin track infections continue to be an anticipated nuisance of using external fixation. For such a common occurrence, however, the data on pin track infections in the external fixation literature remain limited, heterogeneous, and poor in quality.  Depending on the reference, pin track infection rates have been reported to be anywhere from 0% to 100%. ,,,,,, The vast discrepancy between these reported values makes this information difficult to interpret.
Creating a standardized scoring system for reporting pin track infections would help to make future studies on this topic more meaningful. The first step in this process is to attempt to identify a baseline pin track infection rate for external fixators. Once this starting point is established, further research could use this infection rate as a threshold for determining whether an intervention is successful or not. This study aims to critically evaluate the pin track infection rate for external fixation by performing a systematic review of the external fixation literature since 1980. By analyzing a large volume of pin track infection data from the literature, the goal is to define the baseline pin track infection rate for external fixation.
| Materials and Methods|| |
The PRISMA and PICOS guidelines were followed as much as possible during the conduct of this systematic review [Figure 1].  Through PubMed database, a search using the phrase "external fixation" was performed. Under this heading, a total of 9620 articles were identified. The search limits "custom range of dates" (January 1, 1980, to June 30, 2014), "human only," and "English language only" were then created, and this decreased the total number of articles to 5493. The following exclusion criteria were then applied to the search list: Articles pertaining to external fixation of the axial skeleton (cranium/pelvis/spine) were eliminated; case reports were eliminated (a minimum of five patients per article); the results had to report pin track infections as the number of patients affected not by the individual pin or wire; the article had to be accessible via the online library of the primary author's institution. This process reduced the number of eligible studies to a final total of 150 that were then analyzed completely.
For each article reviewed, the following data points were extracted: Year of publication, number of patients in the study, average age, reason for the external fixation (trauma, lengthening, deformity correction, etc.), amount of fixation per segment (2 points or more than 2 points), body part involved (distal radius, femur, tibia, humerus, etc.), whether hydroxyapatite (HA)-coated pins were used or not, duration of the external fixator, type of fixator used (circular versus uniplanar design), number of patients with documented pin track infections.
A weighted multiple regression analysis was performed using SPSS Statistics Version 21 (IBM, Armonk, New York, USA). The analysis was weighted linearly based on the number of patients in each study. Pin track infection was the dependent variable. Independent variables included years since publication date; average age; treatment of trauma, deformity, or length discrepancy; location in the tibia, femur, lower extremity (hip, femur, knee, tibia, or foot), distal radius, humerus, upper extremity (shoulder, humerus, elbow, distal radius, or hand); presence of two or three pins per fixation unit, use of HA pins; and uniplanar or circular construct. Standard dummy coding was used for locations, pin number, and fixator construct. Studies that neither specify nor had a mixed group of any variable were assigned zeros in the dummy coding. Studies were excluded pairwise. In the multiple regression analysis, multicollinearity was assessed as negative based on variance inflation factor <10 and coefficient tolerance >0.1 and with intervariable correlations of lower than 0.7. The multiple regression analysis was repeated after removing any variable that violated multicollinearity. The lack of any undue influence from outliers was confirmed with a Cook's distance <1. Significant values were based on P < 0.05. Deformity as an indication, upper extremity location, and uniplanar construct was excluded from the analysis due to multicollinearity. Standardized beta values represent the relative contribution of each independent variable to pin track infection. For example, for age, –0.344 squared is 0.118 indicating that 11.8% of total pin track infection rate variance is explained by patient age. Unstandardized beta values represent the actual contribution of each variable to pin track infection. For example, for years from publication, –0.005 can be multiplied by 10 years to produce –0.05, indicating that one would expect 5% lower rate of pin track infection if a study was published 10 years earlier.
| Results|| |
A total of 150 published peer-reviewed studies on external fixation were analyzed. ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, Each year between 1980 and 2014 was represented by at least one study. The 150 studies represented 6130 patients. There were 1684 patients reported pin track infections from these 6130 patients giving an overall pin track infection rate of 27.4% [Figure 2].
|Figure 2: A bubble plot where the volume of each circle represents the number of patients in each reviewed study, with studies listed in chronological order|
Click here to view
[Table 1] lists the multiple regression results. More recent year of publication was associated with an increasing infection rate (P = 0.015) while increasing age was associated with a decreased infection rate (P < 0.0005). There were trends toward association of humerus location (P = 0.059), shorter duration (P = 0.056), and circular fixation (P = 0.079) with decreased infection rate.
The pin track infection rate for pediatric patients (under age 18) was 38% (717/1893). The pin track infection rate for adult patients (age 18 and over) was 24% (896/3800). Among the adult patients, the 18-39-year-old age group had an infection rate of 27% (556/2082), the 40-64-year-old age group had 23% infection rate (309/1329), and the 65 and over years old age group had 8% infection rate (31/389).
The three most common etiologies for frame usage were trauma, deformity correction, and lengthening. Trauma patients had a pin track infection rate of 24% (986/4161). Deformity correction patients had a pin track infection rate of 29% (348/1199). Limb lengthening patients had a pin track infection rate of 46% (239/512).
The duration of time the frame was on the patient was analyzed. For a fixator removed in 42 days or less, the pin track infection rate was 19.6% (191/972). For frames with duration between 43 and 90 days, the pin track infection rate was 24.2% (475/1956). For frames removed between 91 and 150 days after application, the pin track infection rate was 27.2% (498/1828). For frames removed after >150 days, the pin track infection rate was 37.8% (440/1161). For frames removed over >180 days, the pin track infection rate was 47.8% (335/700).
The pin track infection rate was different depending on the frame location [Table 2]. Distal radius fixators had the lowest pin track infection rate at 12% (139/1122). Tibial external fixators had the highest pin track infection rate at 33% (754/2278). Upper extremity fixators had an overall pin track infection rate of 14% (213/1511) compared to 31% in the lower extremity (1285/4155).
The effect of pin coating on the pin track infection rate was determined. HA-coated pins had 29.5% (71/240) pin track infection rate while non-HA-coated pins had 25.9% (1457/5609) infection rate.
Circular external fixators had 29.5% (457/1545) pin track infection rate compared to 22.9% (937/4089) pin track infection rate in uniplanar fixators. Details comparing the etiology of frame use and duration of frame use for circular and uniplanar fixators are provided in [Table 2].
Pin track infections were evaluated by decade. The pin track infection rate in the 1980s was 23.2% (301/1295). The pin track infection in the 1990s was 25.9% (424/1631). The pin track infection rate in the 2000s was 36.1% (573/1583). The pin track infection rate from 2011 to 2014 was 23.8% (386/1621). Details of the frame usage by decade are provided in [Table 3].
The stability of the fixation was analyzed. Many of the trauma articles, especially those involving pediatric and upper extremity fractures, only used two half pins in each bone segment. Patients with only two points of fixation per segment had 21.5% (566/2629) infection rate compared to 30.5% (651/2131) infection rate in patients with three or more points of fixation per segment. Details on the number of points of fixation per segment by patient etiology and frame duration are provided in [Table 4].
| Discussion|| |
This systematic review provides a better estimate of pin track infection rates than what has been previously published. By gathering such a large volume of data, the authors tried to mitigate some of the discrepancies in the available literature. A review of 150 external fixation studies comprising 6130 patients was performed. ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, Each year from 1980 to 2014 was represented by at least one article. A total of 1684 pin track infections were reported, producing a cumulative pin track infection rate of 27.4%. This indicates the inherent risk of any given patient developing a pin track infection at a random pin or wire site during the course of treatment with external fixation. Pin track infections are an anticipated nuisance associated with external fixation. Attempts have been made to decrease the risk of pin track infections by improving the stability of the pin-bone interface and by developing different pin care regimens. ,,,,,, There have also been modifications of the surgical techniques to decrease the risk of pin track infection such as using integrated fixation to remove the external fixators more quickly. ,,,, Despite these improvements, however, pin track infections remain common in patients undergoing external fixation. This systematic analysis of 6130 patients in the literature found an overall pin track infection rate of 27.4%.
The pin track infection rate appears to be influenced, however, by multiple variables. In the regression analysis, standardized beta indicates the magnitude of each variable's effect on pin track infections. The variable with the greatest effect was patient age followed by publication year, circular fixation, and duration in decreasing order. Patient age and publication year had statistically significant effect (P < 0.05) while circular fixation and duration were nearly significant.
Examination of the patient's age demonstrates that pediatric patients have the highest risk of infection at 38%. Patients aged 65 and over had 4.75 times less risk of developing a pin track infection (8%). This information seems counterintuitive given that pediatric patients generally have competent immune systems without additional medical comorbidities. It is possible that adult patients are more compliant with the pin care regimen than pediatric patients. Unlike the adult patients who care for themselves, many pediatric patients rely on others to perform the pin care. This may lead to less regular care, especially from parents who are concerned about hurting their children while performing pin care or who simply do not have time to perform it on a consistent basis. Pediatric patients also had their frames on longer than patients aged 65 and older. Pediatric patients had the frame removed in six weeks or less 5% of the time (92/1893) compared to 38% (148/389) in aged 65 and older patients. The frame duration was 180 days or longer in 20% of the pediatric patients (377/1893) compared to only 2% in the 65 and over group (7/389). Another possible explanation is that pediatric patients have used frames for more complicated procedures than elderly patients. No frames for deformity correction or lengthening were used in the elderly population while 39% of the pediatric cases (736/1893) were deformity corrections and 21% were limb lengthening cases (397/1893). The increased complexity of the cases combined with the increased duration of the frame was probably influenced the difference in the age group pin track infection rate. Finally, pediatric patients are often quite active in their frames which can lead to increased friction at the pin-site interface as well as additional external contamination.
The pin track infection rate appears to have been getting worse over time despite improvements in technology and experience with statistical significance in the multiple regression analysis. The 1980s had the lowest rate of infection of all time periods (23.2%), and the pin track infection rate increased each decade from the 1980s to the first decade of the 21 st century (1990s = 25.9%, 2000s = 36.1%). The data from the last 5 years, however, show a recovery back toward the pin track infection rate of the 1980s (2010-2014 = 23.8%). It is hard to explain the differences in each decade since there were over 1200 patients in each group. The first decade of the 21 st century had the highest number of limb lengthening cases and the least number of trauma cases. Thus, these trends may reflect the increased use of external fixation for more complicated cases with time. Changes in the definition of a pin track infection with time may have also influenced this trend. Finally, it is recognized that the year of publication does not necessarily reflect the date of treatment. A group of patients may have been collected over a long period and therefore do not fully represent the pin track infection of the year (or decade) of publication.
Circular external fixators had a higher pin track infection rate (29.5%) than the uniplanar fixators (22.9%). This most likely represents a difference in usage rather than a true difference in pin track infection. The circular frames were used for a higher percentage of limb lengthening (10% to 4%) and deformity correction cases (33% to 13%) than the uniplanar frames. The circular fixators, therefore, also had a longer average duration on each patient exposing the pins to potential infection for a greater period. Circular frames were used for longer than 180 days in 17.6% of patients (273/1545) compared to 6.9% of patients (276/3959) in uniplanar frames. In the multiple regression analysis, circular external fixation actually trended toward a protective effect against pin track infections supporting the difference in usage.
The duration of external fixation trended toward a large influence on pin track infection rate. There was a steady increase in pin track infection rate as the length of external fixation increased. For frames removed within six weeks, the pin track infection rate was only 19.6%. The pin track infection rate grew 2.4 times higher (47.8%) in patients with external fixation for over 180 days. This supports the idea that the pin-skin interface degrades over time. The longer the pins are exposed to bacteria the more likely they are to become infected.
The etiology of the frame use (trauma, deformity correction, limb lengthening) produced gradually increasing pin track infection rates. Trauma patients had the lowest pin infection risk at 24% while limb lengthening had the highest risk at 46%. Frames for deformity correction were in-between these two groups with an average pin track infection rate of 29%. The differing pin track infection rates may be related to the duration of fixation. The trauma external fixators were removed in an average of 88 days while the limb lengthening frames remained on each patient more than twice as long with an average of 198 days.
The location of the frame on the body seemed to affect the rate of pin track infection. The distal radius had the lowest rate of infection at 12%, and the tibia had the highest rate of infection at 33%. The humerus and femur were intermediate with pin track infection rates of 23% and 26%, respectively. In the multiple regression analysis, there was a trend toward lower pin track infections with a humeral location and no clear effect at the other locations. Intuitively, it would seem that the femur should have the highest pin track infection rate due to the large soft tissue envelope surrounding the half pins and wires in this location. However, the data did not support that theory. Lower extremity pins and wires were twice as likely to become infected (31%) compared to upper extremity pins and wires (14%). Two factors may help explain the discrepancy. First, the upper extremity frames tended to remain in place for shorter periods compared to the lower extremity frames. Second, the upper extremity frames were mainly used for trauma applications rather than more complicated deformity corrections or limb lengthening procedures. It is also possible that there are some inherently protective effects in the upper extremity that allows for a decreased pin track infection risk. The upper extremity usually has a smaller soft tissue envelope than the lower extremity, and the upper extremity is more vascularized than the lower extremity.
The use of HA-coated pins did not seem to show a protective effect to the patient with regards to the pin track infection rate. While the sample size of literature using HA-coated pins is relatively small (240 patients), their pin track infection rate was higher than the pins without the coating. The HA coating enables bone formation directly on its surface by creating a chemical bond between the crystals of the coating and those of the newly formed bone.  This has been shown to increase the removal torque for half pins, indicating improved stability of the pin-bone interface over time, especially in metaphyseal bone. ,, Despite its ability to improve the pin-bone interface, however, HA coatings have no direct antibacterial effect and are still vulnerable to bacterial infection like uncoated pins. Infections of external fixator pins are the result of bacterial adhesion followed by the development of a biofilm.  For a pin coating to effectively decrease the risk of pin track infection, it would need to contain an active antimicrobial agent that lasts for the duration of pin implantation. This concept has been attempted unsuccessfully in the past with the use of silver.  Iodine-supported titanium half pins, however, have recently been developed and represent a promising potential advancement in the prevention of pin track infection. 
This study has several limitations. Most importantly, the definition of a pin track infection is not standardized, and the results reported in each individual article vary depending on the method used to diagnose the infection. The literature on pin track infections is therefore difficult to interpret, and published rates of pin track infection vary widely, from 0% to 100% depending on the source of the information. ,,,,,, There are many reasons for this considerable discrepancy, and several classification schemes have been proposed with different criteria for identifying a pin track infection. ,,,, In addition, some authors choose to report the pin track infection rate as the number of patients who develop an infection over the course of treatment. This is the most common method of reporting but it has potential flaws. This reporting technique does not indicate if the patient has more than one pin or wire infected and it does not indicate if the same pin became infected more than once during the course of treatment. The alternate method of reporting infections is to calculate the pin track infection rate as the number of pin track infection occurrences divided by the total number of pins or wires. This technique provides more data but it is more difficult and time consuming to monitor. It also does not indicate if the same pin or wire has been infected more than once. Finally, pin track infections are the result of multiple variables. The pin location, the insertion technique used, the patient age, the type of external fixation used, the etiology of the external fixation, the duration of the external fixation, and the presence of any protective coating on the pin are some of the factors that can influence whether or not a pin track becomes infected. This information is typically consolidated in the external fixation literature, making it difficult to get a true sense of the pin track infection rate.
In summary, this systematic review of pin track infections associated with external; fixation revealed a cumulative rate of 27%. Younger age was the largest factor leading to increased pin track infection rates. Circular fixation trended toward being protective of pin track infection when this was factored into the multiple regression analysis. Longer duration of fixation trended toward increased infection rate as expected. Later publication year was associated with increased infection rate, possibly related to either changes in use or changes in the definition of a pin track infection over time. These data provide important base values for a common complication in external fixation treatment, highlight the importance of a more consistent definition of a pin track infection in future research, and identify the pediatric population as a the group at greatest risk. Developing a standardized scoring system for each pin or wire site may help to eliminate some of the many variables that have been the source of confusion in existing pin track infection literature.
| Conclusion|| |
This systematic review of external fixation publications revealed a cumulative pin track infection rate of 27%. Younger age was the factor leading to increased pin track infection rates. Circular fixation trended toward being protective of pin track infection when usage was factored into the multiple regression analysis. Longer duration of fixation trended toward increased infection rate as expected. This data provides important base values for a common complication in external fixation treatment, highlight the importance of a more consistent definition of a pin track infection in future research, and identify the pediatric population as the group at greatest risk.
We would like to thank Jordan Grauer for assistance in the preparation of this manuscript.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Lethaby A, Temple J, Santy-Tomlinson J. Pin site care for preventing infections associated with external bone fixators and pins. Cochrane Database Syst Rev 2013;12:CD004551.
Sims M, Saleh M. External fixation - The incidence of pin site infection: A prospective audit. J Orthop Nurs 2000;4:59-63.
Moroni A, Vannini F, Mosca M, Giannini S. State of the art review: Techniques to avoid pin loosening and infection in external fixation. J Orthop Trauma 2002;16:189-95.
Parameswaran AD, Roberts CS, Seligson D, Voor M. Pin tract infection with contemporary external fixation: How much of a problem? J Orthop Trauma 2003;17:503-7.
Cavusoglu AT, Er MS, Inal S, Ozsoy MH, Dincel VE, Sakaogullari A. Pin site care during circular external fixation using two different protocols. J Orthop Trauma 2009;23:724-30.
Holt J, Hertzberg B, Weinhold P, Storm W, Schoenfisch M, Dahners L. Decreasing bacterial colonization of external fixation pins through nitric oxide release coatings. J Orthop Trauma 2011;25:432-7.
Lee CK, Chua YP, Saw A. Antimicrobial gauze as a dressing reduces pin site infection: A randomized controlled trial. Clin Orthop Relat Res 2012;470:610-5.
Ferreira N, Marais LC. Prevention and management of external fixator pin track sepsis. Strategies Trauma Limb Reconstr 2012;7:67-72.
Shamseer L, Moher D, Clarke M, Ghersi D, Liberati A, Petticrew M, et al.
Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: Elaboration and explanation. BMJ 2015;349:g7647.
Edge AJ, Denham RA. External fixation for complicated tibial fractures. J Bone Joint Surg Br 1981;63-B: 92-7.
Court-Brown C, Hughes SP. Experience with the Sukhtian - Hughes external fixation system. J R Soc Med 1982;75:949-57.
Coppola AJ Jr., Anzel SH. Use of the Hoffmann external fixator in the treatment of femoral fractures. Clin Orthop Relat Res 1983;180:78-82.
Velazco A, Fleming LL. Open fractures of the tibia treated by the Hoffmann external fixator. Clin Orthop Relat Res 1983;180:125-32.
Cooney WP. External fixation of distal radial fractures. Clin Orthop Relat Res 1983;180:44-9.
Larsson K, van der Linden W. Open tibial shaft fractures. Clin Orthop Relat Res 1983;180:63-7.
Karlström G, Olerud S. External fixation of severe open tibial fractures with the Hoffmann frame. Clin Orthop Relat Res 1983;180:68-77.
Stephens DC. Femoral and tibial lengthening. J Pediatr Orthop 1983;3:424-30.
Tolo VT. External skeletal fixation in children's fractures. J Pediatr Orthop 1983;3:435-42.
Hedley AK, Bernstein ML. External fixation as a secondary procedure. Clin Orthop Relat Res 1983;173:209-15.
Dabezies EJ, D'Ambrosia R, Shoji H, Norris R, Murphy G. Fractures of the femoral shaft treated by external fixation with the Wagner device. J Bone Joint Surg Am 1984;66:360-4.
Green SA, Garland DE, Moore TJ, Barad SJ. External fixation for the uninfected angulated nonunion of the tibia. Clin Orthop Relat Res 1984;190:204-11.
Vaughan PA, Lui SM, Harrington IJ, Maistrelli GL. Treatment of unstable fractures of the distal radius by external fixation. J Bone Joint Surg Br 1985;67:385-9.
Court-Brown CM, Hughes SP. Hughes external fixator in treatment of tibial fractures. J R Soc Med 1985;78:830-7.
Behrens F, Searls K. External fixation of the tibia. Basic concepts and prospective evaluation. J Bone Joint Surg Br 1986;68:246-54.
Foster DE, Kopta JA. Update on external fixators in the treatment of wrist fractures. Clin Orthop Relat Res 1986;204:177-83.
Kristiansen B, Kofoed H. External fixation of displaced fractures of the proximal humerus. Technique and preliminary results. J Bone Joint Surg Br 1987;69:643-6.
Jenkins NH, Jones DG, Johnson SR, Mintowt-Czyz WJ. External fixation of Colles' fractures. An anatomical study. J Bone Joint Surg Br 1987;69:207-11.
Clyburn TA. Dynamic external fixation for comminuted intra-articular fractures of the distal end of the radius. J Bone Joint Surg Am 1987;69:248-54.
McCoy GF, Orr JF, Templeton J. External fixation in contemporary fracture management. Ulster Med J 1987;56:81-9.
Alonso JE, Horowitz M. Use of the AO/ASIF external fixator in children. J Pediatr Orthop 1987;7:594-600.
Rand JA, Bryan RS, Chao EY. Failed total knee arthroplasty treated by arthrodesis of the knee using the Ace-Fischer apparatus. J Bone Joint Surg Am 1987;69:39-45.
Edwards CC, Simmons SC, Browner BD, Weigel MC. Severe open tibial fractures. Results treating 202 injuries with external fixation. Clin Orthop Relat Res 1988;230:98-115.
Paterson JM, Waller CS, Catterall A. Lower limb lengthening by a modified Wagner technique. J Pediatr Orthop 1989;9:129-33.
Maurer DJ, Merkow RL, Gustilo RB. Infection after intramedullary nailing of severe open tibial fractures initially treated with external fixation. J Bone Joint Surg Am 1989;71:835-8.
Kongsholm J, Olerud C. Plaster cast versus external fixation for unstable intraarticular Colles' fractures. Clin Orthop Relat Res 1989;241:57-65.
Holbrook JL, Swiontkowski MF, Sanders R. Treatment of open fractures of the tibial shaft: Ender nailing versus external fixation. A randomized, prospective comparison. J Bone Joint Surg Am 1989;71:1231-8.
Grill F. Correction of complicated extremity deformities by external fixation. Clin Orthop Relat Res 1989;241:166-76.
Howard PW, Stewart HD, Hind RE, Burke FD. External fixation or plaster for severely displaced comminuted Colles' fractures? A prospective study of anatomical and functional results. J Bone Joint Surg Br 1989;71:68-73.
Bach AW, Hansen ST Jr. Plates versus external fixation in severe open tibial shaft fractures. A randomized trial. Clin Orthop Relat Res 1989;241:89-94.
Nagano A, Okinaga S, Ochiai N, Kurokawa T. Shoulder arthrodesis by external fixation. Clin Orthop Relat Res 1989;247:97-100.
Cattaneo R, Villa A, Catagni MA, Bell D. Lengthening of the humerus using the Ilizarov technique. Description of the method and report of 43 cases. Clin Orthop Relat Res 1990;250:117-24.
Thakur AJ, Patankar J. Open tibial fractures. Treatment by uniplanar external fixation and early bone grafting. J Bone Joint Surg Br 1991;73:448-51.
Jakim I, Pieterse HS, Sweet MB. External fixation for intra-articular fractures of the distal radius. J Bone Joint Surg Br 1991;73:302-6.
Roumen RM, Hesp WL, Bruggink ED. Unstable Colles' fractures in elderly patients. A randomised trial of external fixation for redisplacement. J Bone Joint Surg Br 1991;73:307-11.
Dhal A, Varghese M, Bhasin VB. External fixation of intertrochanteric fractures of the femur. J Bone Joint Surg Br 1991;73:955-8.
Tucker HL, Kendra JC, Kinnebrew TE. Management of unstable open and closed tibial fractures using the Ilizarov method. Clin Orthop Relat Res 1992;280:125-35.
Proubasta IR. Rolando's fracture of the first metacarpal. Treatment by external fixation. J Bone Joint Surg Br 1992;74:416-7.
Bell DF, Boyer MI, Armstrong PF. The use of the Ilizarov technique in the correction of limb deformities associated with skeletal dysplasia. J Pediatr Orthop 1992;12:283-90.
Velazquez RJ, Bell DF, Armstrong PF, Babyn P, Tibshirani R. Complications of use of the Ilizarov technique in the correction of limb deformities in children. J Bone Joint Surg Am 1993;75:1148-56.
Bonnard C, Favard L, Sollogoub I, Glorion B. Limb lengthening in children using the Ilizarov method. Clin Orthop Relat Res 1993;293:83-8.
Marsh JL, Prokuski L, Biermann JS. Chronic infected tibial nonunions with bone loss. Conventional techniques versus bone transport. Clin Orthop Relat Res 1994;301:139-46.
Tornetta P 3 rd
, Bergman M, Watnik N, Berkowitz G, Steuer J. Treatment of grade-IIIb open tibial fractures. A prospective randomised comparison of external fixation and non-reamed locked nailing. J Bone Joint Surg Br 1994;76:13-9.
Sommerkamp TG, Seeman M, Silliman J, Jones A, Patterson S, Walker J, et al.
Dynamic external fixation of unstable fractures of the distal part of the radius. A prospective, randomized comparison with static external fixation. J Bone Joint Surg Am 1994;76:1149-61.
Davis TJ, Topping RE, Blanco JS. External fixation of pediatric femoral fractures. Clin Orthop Relat Res 1995;318:191-8.
Kanel JS, Price CT. Unilateral external fixation for corrective osteotomies in patients with hypophosphatemic rickets. J Pediatr Orthop 1995;15:232-5.
Marsh JL, Smith ST, Do TT. External fixation and limited internal fixation for complex fractures of the tibial plateau. J Bone Joint Surg Am 1995;77:661-73.
Price CT, Scott DS, Greenberg DA. Dynamic axial external fixation in the surgical treatment of tibia vara. J Pediatr Orthop 1995;15:236-43.
Stanitski DF, Bullard M, Armstrong P, Stanitski CL. Results of femoral lengthening using the Ilizarov technique. J Pediatr Orthop 1995;15:224-31.
Marsh JL, Bonar S, Nepola JV, Decoster TA, Hurwitz SR. Use of an articulated external fixator for fractures of the tibial plafond. J Bone Joint Surg Am 1995;77:1498-509.
Noordeen MH, Lavy CB, Shergill NS, Tuite JD, Jackson AM. Cyclical micromovement and fracture healing. J Bone Joint Surg Br 1995;77:645-8.
Pritchett JW. External fixation or closed medullary pinning for unstable Colles fractures? J Bone Joint Surg Br 1995;77:267-9.
Moens P, Lammens J, Molenaers G, Fabry G. Femoral derotation for increased hip anteversion. A new surgical technique with a modified Ilizarov frame. J Bone Joint Surg Br 1995;77:107-9.
Gaudinez R, Adar U. Use of orthofix T-garche fixator in late-onset tibia vara. J Pediatr Orthop 1996;16:455-60.
Stanitski DF, Shahcheraghi H, Nicker DA, Armstrong PF. Results of tibial lengthening with the Ilizarov technique. J Pediatr Orthop 1996;16:168-72.
Blasier RD, Aronson J, Tursky EA. External fixation of pediatric femur fractures. J Pediatr Orthop 1997;17:342-6.
Hull JB, Sanderson PL, Rickman M, Bell MJ, Saleh M. External fixation of children's fractures: Use of the orthofix dynamic axial fixator. J Pediatr Orthop B 1997;6:203-6.
Stanitski DF, Dahl M, Louie K, Grayhack J. Management of late-onset tibia vara in the obese patient by using circular external fixation. J Pediatr Orthop 1997;17:691-4.
Bar-On E, Sagiv S, Porat S. External fixation or flexible intramedullary nailing for femoral shaft fractures in children. A prospective, randomised study. J Bone Joint Surg Br 1997;79:975-8.
Stanitski DF, Srivastava P, Stanitski CL. Correction of proximal tibial deformities in adolescents with the T-garches external fixator. J Pediatr Orthop 1998;18:512-7.
Hosny G, Shawky MS. The treatment of infected non-union of the tibia by compression-distraction techniques using the Ilizarov external fixator. Int Orthop 1998;22:298-302.
Hutson JJ Jr., Zych GA. Infections in periarticular fractures of the lower extremity treated with tensioned wire hybrid fixators. J Orthop Trauma 1998;12:214-8.
Geiger F, Schneider U, Lukoschek M, Ewerbeck V. External fixation in proximal tibial osteotomy: A comparison of three methods. Int Orthop 1999;23:160-3.
Marsh JL, Mahoney CR, Steinbronn D. External fixation of open humerus fractures. Iowa Orthop J 1999;19:35-42.
Skaggs DL, Leet AI, Money MD, Shaw BA, Hale JM, Tolo VT. Secondary fractures associated with external fixation in pediatric femur fractures. J Pediatr Orthop 1999;19:582-6.
Miner T, Carroll KL. Outcomes of external fixation of pediatric femoral shaft fractures. J Pediatr Orthop 2000;20:405-10.
Yun AG, Severino R, Reinker K. Attempted limb lengthenings beyond twenty percent of the initial bone length: Results and complications. J Pediatr Orthop 2000;20:151-9.
Bennek J. The use of upper limb external fixation in paediatric trauma. Injury 2000;31 Suppl 1:21-6.
Smith SL, Beckish ML, Winters SC, Pugh LI, Bray EW. Treatment of late-onset tibia vara using afghan percutaneous osteotomy and orthofix external fixation. J Pediatr Orthop 2000;20:606-10.
Arazi M, Memik R, Ogün TC, Yel M. Ilizarov external fixation for severely comminuted supracondylar and intercondylar fractures of the distal femur. J Bone Joint Surg Br 2001;83:663-7.
Kato H, Minami A, Suenaga N, Iwasaki M, Kimura T. Callotasis lengthening in patients with brachymetacarpia. J Pediatr Orthop 2002;22:497-500.
Pommer A, Muhr G, Dávid A. Hydroxyapatite-coated Schanz pins in external fixators used for distraction osteogenesis: A randomized, controlled trial. J Bone Joint Surg Am 2002;84-A: 1162-6.
Domb BG, Sponseller PD, Ain M, Miller NH. Comparison of dynamic versus static external fixation for pediatric femur fractures. J Pediatr Orthop 2002;22:428-30.
Feldman DS, Shin SS, Madan S, Koval KJ. Correction of tibial malunion and nonunion with six-axis analysis deformity correction using the Taylor spatial frame. J Orthop Trauma 2003;17:549-54.
Handelsman JE, Weinberg J, Razi A, Mulley DA. The role of AO external fixation in proximal femoral osteotomies in the pediatric neuromuscular population. J Pediatr Orthop B 2004;13:303-7.
El Hayek T, Daher AA, Meouchy W, Ley P, Chammas N, Griffet J. External fixators in the treatment of fractures in children. J Pediatr Orthop B 2004;13:103-9.
Wong J, Boyd R, Keenan NW, Baker R, Selber P, Wright JG, et al.
Gait patterns after fracture of the femoral shaft in children, managed by external fixation or early hip spica cast. J Pediatr Orthop 2004;24:463-71.
Catagni MA, Lovisetti L, Guerreschi F, Combi A, Ottaviani G. Cosmetic bilateral leg lengthening: Experience of 54 cases. J Bone Joint Surg Br 2005;87:1402-5.
Carmichael KD, Bynum J, Goucher N. Rates of refracture associated with external fixation in pediatric femur fractures. Am J Orthop (Belle Mead NJ) 2005;34:439-44.
Ring D, Hotchkiss RN, Guss D, Jupiter JB. Hinged elbow external fixation for severe elbow contracture. J Bone Joint Surg Am 2005;87:1293-6.
Kubiak EN, Egol KA, Scher D, Wasserman B, Feldman D, Koval KJ. Operative treatment of tibial fractures in children: Are elastic stable intramedullary nails an improvement over external fixation? J Bone Joint Surg Am 2005;87:1761-8.
Moroni A, Faldini C, Pegreffi F, Hoang-Kim A, Vannini F, Giannini S. Dynamic hip screw compared with external fixation for treatment of osteoporotic pertrochanteric fractures. A prospective, randomized study. J Bone Joint Surg Am 2005;87:753-9.
Handelsman JE, Weinberg J, Friedman S. The role of the small AO external fixator in supracondylar rotational femoral osteotomies. J Pediatr Orthop B 2005;14:194-7.
Gausepohl T, Mader K, Pennig D. Mechanical distraction for the treatment of posttraumatic stiffness of the elbow in children and adolescents. J Bone Joint Surg Am 2006;88:1011-21.
Freedman JA, Watts H, Otsuka NY. The Ilizarov method for the treatment of resistant clubfoot: Is it an effective solution? J Pediatr Orthop 2006;26:432-7.
Martin JN, Vialle R, Denormandie P, Sorriaux G, Gad H, Harding I, et al.
Treatment of knee flexion contracture due to central nervous system disorders in adults. J Bone Joint Surg Am 2006;88:840-5.
Handelsman JE, Weinberg J, Hersch JC. Corrective supracondylar humeral osteotomies using the small AO external fixator. J Pediatr Orthop B 2006;15:194-7.
Kocaoglu M, Eralp L, Rashid HU, Sen C, Bilsel K. Reconstruction of segmental bone defects due to chronic osteomyelitis with use of an external fixator and an intramedullary nail. J Bone Joint Surg Am 2006;88:2137-45.
Egol KA, Paksima N, Puopolo S, Klugman J, Hiebert R, Koval KJ. Treatment of external fixation pins about the wrist: A prospective, randomized trial. J Bone Joint Surg Am 2006;88:349-54.
Norrish AR, Lewis CP, Harrison WJ. Pin-track infection in HIV-positive and HIV-negative patients with open fractures treated by external fixation: A prospective, blinded, case-controlled study. J Bone Joint Surg Br 2007;89:790-3.
Carbonell PG, Valero JV, Fernández PD, Vicente-Franqueira JR. Monolateral external fixation for the progressive correction of neurological spastic knee flexion contracture in children. Strategies Trauma Limb Reconstr 2007;2:91-7.
Tsuchiya H, Morsy AF, Matsubara H, Watanabe K, Abdel-Wanis ME, Tomita K. Treatment of benign bone tumours using external fixation. J Bone Joint Surg Br 2007;89:1077-83.
Ramseier LE, Bhaskar AR, Cole WG, Howard AW. Treatment of open femur fractures in children: Comparison between external fixator and intramedullary nailing. J Pediatr Orthop 2007;27:748-50.
Myers SH, Spiegel D, Flynn JM. External fixation of high-energy tibia fractures. J Pediatr Orthop 2007;27:537-9.
Moroni A, Faldini C, Hoang-Kim A, Pegreffi F, Giannini S. Alendronate improves screw fixation in osteoporotic bone. J Bone Joint Surg Am 2007;89:96-101.
Zhang X, Liu T, Li Z, Peng W. Reconstruction with callus distraction for nonunion with bone loss and leg shortening caused by suppurative osteomyelitis of the femur. J Bone Joint Surg Br 2007;89:1509-14.
Eidelman M, Bialik V, Katzman A. The use of the Taylor spatial frame in adolescent Blount's disease: Is fibular osteotomy necessary? J Child Orthop 2008;2:199-204.
Marangoz S, Feldman DS, Sala DA, Hyman JE, Vitale MG. Femoral deformity correction in children and young adults using Taylor spatial frame. Clin Orthop Relat Res 2008;466:3018-24.
Naqui SZ, Thiryayi W, Foster A, Tselentakis G, Evans M, Day JB. Correction of simple and complex pediatric deformities using the Taylor-spatial frame. J Pediatr Orthop 2008;28:640-7.
Kiss S, Pap K, Vízkelety T, Terebessy T, Balla M, Szoke G. The humerus is the best place for bone lengthening. Int Orthop 2008;32:385-8.
McCarthy JJ, Ranade A, Davidson RS. Pediatric deformity correction using a multiaxial correction fixator. Clin Orthop Relat Res 2008;466:3011-7.
Slongo T, Schmid T, Wilkins K, Joeris A. Lateral external fixation - A new surgical technique for displaced unreducible supracondylar humeral fractures in children. J Bone Joint Surg Am 2008;90:1690-7.
Sung JK, Levin R, Siegel J, Einhorn TA, Creevy WR, Tornetta P 3 rd
. Reuse of external fixation components: A randomized trial. J Orthop Trauma 2008;22:126-30.
W-Dahl A, Toksvig-Larsen S. No clinical benefits using a new design of pins for external fixation: A randomized study in 50 patients operated on by the hemicallotasis technique. Arch Orthop Trauma Surg 2008;128:661-7.
Antoci V, Ono CM, Antoci V Jr., Raney EM. Pin-tract infection during limb lengthening using external fixation. Am J Orthop (Belle Mead NJ) 2008;37:E150-4.
Erdem M, Sen C, Eralp L, Kocaoglu M, Ozden V. Lengthening of short bones by distraction osteogenesis - Results and complications. Int Orthop 2009;33:807-13.
Clarke SE, McCarthy JJ, Davidson RS. Treatment of Blount disease: A comparison between the multiaxial correction system and other external fixators. J Pediatr Orthop 2009;29:103-9.
Pandya NK, Clarke SE, McCarthy JJ, Horn BD, Hosalkar HS. Correction of Blount's disease by a multi-axial external fixation system. J Child Orthop 2009;3:291-9.
Kim H, Lee SK, Kim KJ, Ahn JH, Choy WS, Kim YI, et al.
Tibial lengthening using a reamed type intramedullary nail and an Ilizarov external fixator. Int Orthop 2009;33:835-41.
Kocaoglu M, Eralp L, Bilen FE, Balci HI. Fixator-assisted acute femoral deformity correction and consecutive lengthening over an intramedullary nail. J Bone Joint Surg Am 2009;91:152-9.
Monga P, Verma R, Sharma VK. Closed reduction and external fixation for displaced proximal humeral fractures. J Orthop Surg (Hong Kong) 2009;17:142-5.
Abramo A, Kopylov P, Geijer M, Tägil M. Open reduction and internal fixation compared to closed reduction and external fixation in distal radial fractures: A randomized study of 50 patients. Acta Orthop 2009;80:478-85.
McCarthy JJ, Kozin SH, Tuohy C, Cheung E, Davidson RS, Noonan K. External fixation and centralization versus external fixation and ulnar osteotomy: The treatment of radial dysplasia using the resolved total angle of deformity. J Pediatr Orthop 2009;29:797-803.
Schmelzer-Schmied N, Wieloch P, Martini AK, Daecke W. Comparison of external fixation, locking and non-locking palmar plating for unstable distal radius fractures in the elderly. Int Orthop 2009;33:773-8.
Haddad M, Rubin G, Soudry M, Rozen N. External fixation for the treatment of intra-articular fractures of the distal radius: Short-term results. Isr Med Assoc J 2010;12:406-9.
Giannicola G, Sacchetti FM, Greco A, Gregori G, Postacchini F. Open reduction and internal fixation combined with hinged elbow fixator in capitellum and trochlea fractures. Acta Orthop 2010;81:228-33.
Kapoor SK, Kataria H, Patra SR, Boruah T. Capsuloligamentotaxis and definitive fixation by an ankle-spanning Ilizarov fixator in high-energy pilon fractures. J Bone Joint Surg Br 2010;92:1100-6.
Belloti JC, Tamaoki MJ, Atallah AN, Albertoni WM, dos Santos JB, Faloppa F. Treatment of reducible unstable fractures of the distal radius in adults: A randomised controlled trial of De Palma percutaneous pinning versus bridging external fixation. BMC Musculoskelet Disord 2010;11:137.
Blondel B, Launay F, Glard Y, Jacopin S, Jouve JL, Bollini G. Hexapodal external fixation in the management of children tibial fractures. J Pediatr Orthop B 2010;19:487-91.
Hove LM, Krukhaug Y, Revheim K, Helland P, Finsen V. Dynamic compared with static external fixation of unstable fractures of the distal part of the radius: A prospective, randomized multicenter study. J Bone Joint Surg Am 2010;92:1687-96.
Ramseier LE, Janicki JA, Weir S, Narayanan UG. Femoral fractures in adolescents: A comparison of four methods of fixation. J Bone Joint Surg Am 2010;92:1122-9.
Eidelman M, Zaidman M, Katzman A. Treatment of posttraumatic deformities in children and adolescents using the Taylor spatial frame. Orthopedics 2010;33:253-6.
Pieske O, Kaltenhauser F, Pichlmaier L, Schramm N, Trentzsch H, Löffler T, et al.
Clinical benefit of hydroxyapatite-coated pins compared with stainless steel pins in external fixation at the wrist: A randomised prospective study. Injury 2010;41:1031-6.
Raju P, Kini SG. Loss of correction in unstable comminuted distal radius fractures with external fixation and bone grafting - A long term followup study. J Orthop Surg Res 2011;6:23.
Vekris MD, Lykissas MG, Manoudis G, Mavrodontidis AN, Papageorgiou CD, Korompilias AV, et al.
Proximal screws placement in intertrochanteric fractures treated with external fixation: Comparison of two different techniques. J Orthop Surg Res 2011;6:48.
Petsatodis G, Maliogas G, Karikis J, Christodoulou AG, Venetsanakis G, Sachinis N, et al.
External fixation for stable and unstable intertrochanteric fractures in patients older than 75 years of age: A prospective comparative study. J Orthop Trauma 2011;25:218-23.
Wani N, Baba A, Kangoo K, Mir M. Role of early Ilizarov ring fixator in the definitive management of type II, IIIA and IIIB open tibial shaft fractures. Int Orthop 2011;35:915-23.
Babis GC, Evangelopoulos DS, Kontovazenitis P, Nikolopoulos K, Soucacos PN. High energy tibial plateau fractures treated with hybrid external fixation. J Orthop Surg Res 2011;6:35.
Pieske O, Pichlmaier L, Kaltenhauser F, Schramm N, Rubenbauer B, Greiner A, et al.
Hydroxyapatite-coated pins versus titanium alloy pins in external fixation at the wrist: A controlled cohort study. J Trauma 2011;70:845-51.
Kocaoglu M, Bilen FE, Sen C, Eralp L, Balci HI. Combined technique for the correction of lower-limb deformities resulting from metabolic bone disease. J Bone Joint Surg Br 2011;93:52-6.
Guo Q, Zhang T, Zheng Y, Feng S, Ma X, Zhao F. Tibial lengthening over an intramedullary nail in patients with short stature or leg-length discrepancy: A comparative study. Int Orthop 2012;36:179-84.
Monsell FP, Howells NR, Lawniczak D, Jeffcote B, Mitchell SR. High-energy open tibial fractures in children: Treatment with a programmable circular external fixator. J Bone Joint Surg Br 2012;94:989-93.
Refai MA, Song SH, Song HR. Does short-term application of an Ilizarov frame with transfixion pins correct relapsed clubfoot in children? Clin Orthop Relat Res 2012;470:1992-9.
Al-Sayyad MJ. Taylor spatial frame in the treatment of upper extremity conditions. J Pediatr Orthop 2012;32:169-78.
Basbozkurt M, Kurklu M, Yurttas Y, Demiralp B, Koca K, Kilic C, et al.
Ilizarov external fixation without removal of plate or screws: Effect on hypertrophic and oligotrophic nonunion of the femoral shaft with plate failure. J Orthop Trauma 2012;26:e123-8.
Marsland D, Sanghrajka AP, Goldie B. Static monolateral external fixation for the Rolando fracture: A simple solution for a complex fracture. Ann R Coll Surg Engl 2012;94:112-5.
El-Sayed M, Atef A. Management of simple (types A and B) closed tibial shaft fractures using percutaneous lag-screw fixation and Ilizarov external fixation in adults. Int Orthop 2012;36:2133-8.
Foster PA, Barton SB, Jones SC, Morrison RJ, Britten S. The treatment of complex tibial shaft fractures by the Ilizarov method. J Bone Joint Surg Br 2012;94:1678-83.
Eidelman M, Keren Y, Katzman A. Correction of residual clubfoot deformities in older children using the Taylor spatial butt frame and midfoot Gigli saw osteotomy. J Pediatr Orthop 2012;32:527-33.
Hassan A, Letts M. The management of the neglected congenital foot deformity in the older child with the Taylor spatial frame. J Pediatr Orthop 2012;32:85-92.
Pawar AY, McCoy TH Jr., Fragomen AT, Rozbruch SR. Does humeral lengthening with a monolateral frame improve function? Clin Orthop Relat Res 2013;471:277-83.
Wani MM, Dar RA, Latoo IA, Malik T, Sultan A, Halwai MA. External fixation of pediatric femoral shaft fractures: A consecutive study based on 45 fractures. J Pediatr Orthop B 2013;22:563-70.
Raskolnikov D, Slover JD, Egol KA. The use of a multiplanar, multi-axis external fixator to achieve knee arthrodesis in a worst case scenario: A case series. Iowa Orthop J 2013;33:19-24.
Ruette P, Lammens J. Humeral lengthening by distraction osteogenesis: A safe procedure? Acta Orthop Belg 2013;79:636-42.
Ertürk C, Altay MA, Bilge A, Altay N, Isikan UE. Do additional intramedullary elastic nails improve the results of definitive treatment with external fixation of open tibia fractures? A prospective comparative study. Orthop Traumatol Surg Res 2013;99:208-15.
Ramos T, Ekholm C, Eriksson BI, Karlsson J, Nistor L. The Ilizarov external fixator - a useful alternative for the treatment of proximal tibial fractures. A prospective observational study of 30 consecutive patients. BMC Musculoskelet Disord 2013;14:11.
Ramos T, Karlsson J, Eriksson BI, Nistor L. Treatment of distal tibial fractures with the Ilizarov external fixator - A prospective observational study in 39 consecutive patients. BMC Musculoskelet Disord 2013;14:30.
Malot R, Park KW, Song SH, Kwon HN, Song HR. Role of hybrid monolateral fixators in managing humeral length and deformity correction. Acta Orthop 2013;84:280-5.
Kitoh H, Kitakoji T, Hattori T, Kaneko H, Mishima K, Matsushita M, et al.
A comparative study of blade plate fixation and external fixation in osteotomies for slipped capital femoral epiphysis. J Pediatr Orthop B 2013;22:542-7.
Chen YX, Zheng X, Shi HF, Wangyang YF, Yuan H, Xie XX, et al.
Will the untreated ulnar styloid fracture influence the outcome of unstable distal radial fracture treated with external fixation when the distal radioulnar joint is stable. BMC Musculoskelet Disord 2013;14:186.
Tafazal S, Madan SS, Ali F, Padman M, Swift S, Jones S, et al.
Management of paediatric tibial fractures using two types of circular external fixator: Taylor spatial frame and Ilizarov circular fixator. J Child Orthop 2014;8:273-9.
Gordon JE, Manske MC, Lewis TR, O'Donnell JC, Schoenecker PL, Keeler KA. Femoral lengthening over a pediatric femoral nail: Results and complications. J Pediatr Orthop 2013;33:730-6.
Lee DH, Ryu KJ, Kim BH. Reamed intramedullary nailing has adverse effect on bone regeneration during distraction phase in lengthening of the tibia. Clin Orthop Relat Res 2016; 474:816-24. [Montreal].
Rozbruch SR, Kleinman D, Fragomen AT, Ilizarov S. Limb lengthening and then insertion of an intramedullary nail: A case-matched comparison. Clin Orthop Relat Res 2008;466:2923-32.
Checketts RG. Pin track infection and the principles of pin site care. In: DeBastiani A, Apley AG, Goldberg DE, editors. Orthofix External Fixation in Trauma and Orthopedics. Berlin: Springer; 2000. p. 97-103.
Schalamon J, Petnehazy T, Ainoedhofer H, Zwick EB, Singer G, Hoellwarth ME. Pin tract infection with external fixation of pediatric fractures. J Pediatr Surg 2007;42:1584-7.
Toksvig-Larsen S, Aspenberg P. Bisphosphonate-coated external fixation pins appear similar to hydroxyapatite-coated pins in the tibial metaphysis and to uncoated pins in the shaft. Acta Orthop 2013;84:314-8.
Moroni A, Heikkila J, Magyar G, Toksvig-Larsen S, Giannini S. Fixation strength and pin tract infection of hydroxyapatite-coated tapered pins. Clin Orthop Relat Res 2001;388:209-17.
Saithna A. The influence of hydroxyapatite coating of external fixator pins on pin loosening and pin track infection: A systematic review. Injury 2010;41:128-32.
Jennison T, McNally M, Pandit H. Prevention of infection in external fixator pin sites. Acta Biomater 2014;10:595-603.
Massè A, Bruno A, Bosetti M, Biasibetti A, Cannas M, Gallinaro P. Prevention of pin track infection in external fixation with silver coated pins: Clinical and microbiological results. J Biomed Mater Res 2000;53:600-4.
Shirai T, Watanabe K, Matsubara H, Nomura I, Fujiwara H, Arai Y, et al.
Prevention of pin tract infection with iodine-supported titanium pins. J Orthop Sci 2014;19:598-602.
Popkov D, Popkov A, Haumont T, Journeau P, Lascombes P. Flexible intramedullary nail use in limb lengthening. J Pediatr Orthop 2010;30:910-8.
Paley D. Problems, obstacles, and complications of limb lengthening by the Ilizarov technique. Clin Orthop Relat Res 1990;250:81-104.
Saleh M, Scott BW. Pitfalls and complications in leg lengthening: The Sheffield experience. Semin Orthop 1992;7:207-22.
Dahl MT, Gulli B, Berg T. Complications of limb lengthening. A learning curve. Clin Orthop Relat Res 1994;301:10-8.
Ward P. Care of skeletal pins: A literature review. Nurs Stand 1998;12:34-8.
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4]
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