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Year : 2022  |  Volume : 8  |  Issue : 3  |  Page : 51-58

Identification of fine wire and half-pin loosening for external fixators: A systematic review

1 Department of Orthopaedics, Royal Surrey Foundation Trust, Guildford, United Kingdom
2 University Hospitals Sussex Audrey Emerton Building, Royal Sussex County Hospital, Brighton, United Kingdom
3 Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology & 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 St George's University Hospital NHS Foundation Trust, St George's University of London, London, UK

Correspondence Address:
James Nutt
Department of Orthopaedics, Royal Surrey Foundation Trust, Egerton Road, Guildford, Surrey, GU2 7XX
United Kingdom
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jllr.jllr_33_21

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Introduction: This review article discusses the published methods of identification 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 Preferred Reporting Items for Systematic Reviews and Meta-Analyses 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 micro-computed 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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