The Half - Pin and the Pin Tract :

A lthough the key principles of external fixation have changed little over the years, there remains a significant amount of variation in fixation methods and postoperative care. In particular, use and management of halfpins intended for prolonged reconstruction are the subject of strong opinions and intense debate. Half-pins are commonly available in stainless steel and titanium. They are also available coated with hydroxyapatite (HA), which has been demonstrated to improve fixation strength and decrease rates of pin loosening. Despite this growing body of literature in support of HA-coated half-pins, there remains no standard practice. Regardless of type of half-pin used, there are many different methods of pin placement, with the main differences in technique being predrilling or no predrilling before half-pin placement and placement of the half-pin by hand or by power. Much of this argument stems from concern about thermal necrosis caused during half-pin placement, which many believe to be associated with subsequent pin loosening and pin-tract infections. Although some studies have reported pin-tract infection rates as high as 100%, there is little standardization in prevention or treatment. Surgeons use various methods of pin-site care to prevent infections; this care differs in both frequency (eg, daily, weekly) and procedure (eg, specific cleansing solution). Treatment ranges from use of parenteral or oral antibiotics to pin removal or, in extreme cases, frame removal. There is increasing interest in using circular fixation to treat acute and chronic injuries, and in the near future there likely will be an increase in the number of circular fixators being placed. However, there is a lack of consensus regarding both appropriate application and management of these external fixators. We conducted a study of common trends in use and management of half-pins and in treatment of pin-tract infections in circular fixation by polling subject matter experts, members of the Limb Lengthening and Reconstruction Society (LLRS).