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Year : 2022  |  Volume : 8  |  Issue : 2  |  Page : 138-143

Identification and consequences of fine wire and half-pin loosening for external framing

1 Department of Orthopaedics, Royal Surrey County Hospital Foundation Trust, Brighton, UK
2 Brighton and Sussex NHS Library and Knowledge Services, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
3 Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford; Liverpool Orthopaedic and Trauma Service, Department of Orthopaedic and Trauma Surgery, Liverpool University Hospital Foundation Trust, Liverpool, UK
4 Department of Trauma and Orthopaedics, St George's Healthcare NHS Trust, London, United Kingdom

Correspondence Address:
James Nutt
Department of Orthopaedics, Royal Sussex County Hospital, Eastern Road, Brighton BN2 5BE
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jllr.jllr_26_21

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This review article discusses the published methods of identification and consequences of fine wire and half-pin loosening. The evidence is reviewed and presented for the clinical, radiological, and histological analysis of the half-pin and fine wire to bone interface. Materials and Methods: A PRISMA compliant systematic review was conducted. Studies investigating the use of external fixators with descriptions on measurement of half-pin and fine wire loosening were included in this review. Results: Eight studies were eligible and included. No randomized controlled trials were identified. Torque measurement was most frequently used to quantify the half-pin-to-bone interface, histological analysis was performed by three studies, and radiographic analysis was performed by five papers including plain film and microcomputed tomography CT techniques. Discussion: The available evidence was of poor quality, with a lack of homogeneity in quantitative data for torque measurements and a prevalence of arbitrary figures for the definition of loosening. There was no mechanical analysis of fire wire loosening, and the most common clinical measure used for loosening was a scale validated for infection. Micro-CT was validated against torque figures and appears to be the most repeatable measure which could be applied clinically, however has only been used in canine studies. We recommend a study to compare the clinically relevant measurement of loosening against a standard model to provide a validated method of identification or prediction of half-pin and fine wire loosening.

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