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PubMedDate not supplied

An in vitro biomechanical study of a multiplanar circular external fixator applied to equine third metacarpal bones.

The biomechanical characteristics of a 4-ring circular multiplanar fixator applied to equine third metacarpal bones with a 5 mm mid-diaphyseal osteotomy gap were studied. Smooth Steinmann pins, either 1/8 inch, 3/16 inch, or 1/4 inch, were driven through pilot holes in the bone in a crossed configuration and full pin fashion and fastened to the fixator rings using cannulated fixation bolts. The third metacarpal bone fixator constructs were tested in three different modes (cranial-caudal four-point bending, axial compression, and torsion). Loads of 2,000 N were applied in bending and axial compression tests and a load of 50 N x m was applied during testing in torsion. Fixator stiffness was determined by the slope of the load displacement curves. Three constructs for each pin size were tested in each mode. Comparisons between axial stiffness, bending stiffness, and torsional stiffness for each of the three different pin sizes were made using one-way analysis of variance. There was no visually apparent deformation or permanent damage to the fixator frame, and no third metacarpal bone failure in any of the tests. Plastic deformation occurred in the 1/8 inch pins during bending, compression, and torsion testing. The 3/16 inch and 1/4 inch pins elastically deformed in all testing modes. Mean (+/-SE) axial compressive stiffness for the 1/8 inch, 3/16 inch, and 1/4 inch pin fixator constructs was: 182 +/- 16 N/mm, 397 +/- 21 N/mm, and 566 +/- 8.7 N/mm; bending stiffness was 106 +/- 3.3 N/mm, 410 +/- 21 N/mm, and 548 +/- 12 N/mm; and torsional stiffness was 6.15 +/- 0.82 N x m/degree, 7.14 +/- 0.0 N x m/degree, and 11.9 +/- 1.0 N x m/degree respectively. For statically applied loads our results would indicate that a 4-ring fixator using two 1/4 inch pins per ring may not be stiff enough for repair of an unstable third metacarpal bone fracture in a 450 kg horse.

Animals↗

PubMed2006

The locus of fixation in strabismic amblyopia changes with increasing effort of recognition as assessed by scanning laser ophthalmoscope.

PURPOSE: We performed a qualitative assessment of fixation behaviour in relation to the fovea in patients with strabismic amblyopia. METHODS: The fixation of 25 patients with strabismic amblyopia was examined using a scanning laser ophthalmoscope (SLO). A digital frame grabber board was programmed to scan onto the patient's retina single solid black discs of 5, 10 and 15 degrees in diameter and Landolt Cs in different orientations and corresponding to a visual acuity (VA) of 0.01-0.2 in European decimals. The relative position of the fovea was video-recorded. Fifty video fields per second were plotted as x/y (fixational positions in relation to the fovea) and x/t (motion over time) graphs. RESULTS: Three main groups of patients were seen. Group 1 (n = 6), with a VA of < 0.1, showed a grossly eccentric and unstable locus of fixation independent of size/type of test stimulus used. Group 2 (n = 15), with VA of 0.1-0.8, initially used an eccentric retinal area for fixation that, however, shifted to the fovea with decreasing size and increasing detail of the target for fixation. Group 3 (n = 4), with VA of 0.3-0.8, had stable central fixation throughout. CONCLUSIONS: We speculate that the reduced VA associated with strabismic amblyopia is due to a defective motor control of fixation that can be modulated by recognitional effort.

Adolescent↗

PubMed1988

Morphology of the isolated rat hindquarter preparation: tissue preservation, perfusion heterogeneity and a note on the effect of fixative osmolality.

The isolated rat hindquarter preparation often used for physiological studies was subjected to morphological examination. A two-hour perfusion with balanced oxygenated dextran solution was followed by perfusion fixation with aldehydes. Fixation was performed at isogravimetry when an isotonic fixative was used (2.5% glutaraldehyde in 0.05 M Na cacodylate + 4% dextran 70). Muscle specimens were prepared for light and electron microscopy. Most muscle tissue was well perfused but a limited tissue volume could retain blood after the perfusion period. Within perfused tissue the perfusion result varied macroscopically with some regions apparently not being reached by fixative. Non-fixed tissue was estimated to amount to maximally one fourth of the total tissue mass. Also within macroscopically well-fixed tissue the microscopy indicated varying patency of perfused capillaries. Thus a marked perfusion flow heterogeneity prevailed in the fixed specimens which is compatible with earlier functional findings of a 50% reduction of capillary surface area during isogravimetric fixation. The possible relation with prefixation flow heterogeneity in the vasodilated preparation is discussed. There were no obvious alterations of endothelial ultrastructure after prolonged artificial perfusion. Isogravimetrically fixed muscle had narrow extracellular spaces which were evidently compressed further after use of absorbing hyperosmolar fixative. Extracellular expansion and intracellular oedema followed after hypo-osmolar fixation. Muscle cells often exhibited insufficient mitochondrial fixation, probably as a result of tissue hypoxia.

Aldehydes↗

PubMed1962

Physiology of nitrogen fixation by Bacillus polymyxa.

Grau, F. H. (University of Wisconsin, Madison) and P. W. Wilson. Physiology of nitrogen fixation by Bacillus polymyxa. J. Bacteriol. 83:490-496. 1962.-Of 17 strains of Bacillus polymyxa tested for fixation of molecular nitrogen, 15 fixed considerable quantities (30 to 150 mug N/ml). Two strains of the closely related B. macerans did not use N(2), but possibly other members of this species may do so. Confirmation of fixation was obtained by showing incorporation of N(15) into cell material. Both iron and molybdenum are specifically required for fixation; without the addition of these metals to the nitrogen-free medium, the growth rate and the total nitrogen fixed were reduced about 30 to 50%. No requirement for added molybdenum could be shown when ammonia was the nitrogen source, and the absence of iron caused only a slight decrease in growth. Washed-cell suspensions of B. polymyxa containing an active hydrogenase readily incorporated N(15) into cell materials when provided with mannitol, glucose, or pyruvate but not when formate was the substrate. Hydrogen is a specific inhibitor of fixation, reducing both the rate and final amount of nitrogen fixed; it did not reduce growth on ammonia. Fixation was strictly anaerobic, 1% oxygen in the gas phase being sufficient to stop fixation. Arsenate is a powerful inhibitor of fixation of N(2) by washed-cell suspensions of B. polymyxa, indicating that high-energy phosphate may be significant for this process.

Bacillus↗

PubMed1981

Human intestinal mucosal mast cells: evaluation of fixation and staining techniques.

The staining properties of tissue mast cells are influenced by the method of fixation. Differences in fixation and staining techniques may explain the contradictory results in the published reports on the number of human mucosal mast cells (MMC) in the gastrointestinal mucosa in health and disease. We have examined the influence of fixatives on the staining properties of human MMC in operative biopsy specimens of human jejunum. Specimens were divided into pieces, each of which was fixed in one of the following fixatives: Carnoy's, basic lead acetate (BLA), Baker's, Bouin's, isotonic formol-acetic-acid (IFAA), 10% neutral buffered formalin, formol sublimate, and formol saline. Thereafter, tissues were paraffin-embedded and 5 micron sections were cut and stained with either astra-blue/safranin pH 0.3, or toluidine blue pH 0.5. Counts of the number of MMC/mm2 were obtained for each fixation method. The results show a critical influence of the fixative on the number of mast cells identified after staining. For example with astra-blue/safranin the mean MMC/mm2 count was 40 in formol-saline-fixed specimens, and 268 in Carnoy's-fixed specimens. In biopsies fixed with formalin-based fixatives, mast cells were more readily stained with toluidine blue. It is recommended that Carnoy's or BLA be used as the fixative for any light microscopic study of human MMC.

Cell Count↗

PubMed1994

Immunohistochemical demonstration of c-erbB-2 oncoprotein in gastric adenocarcinoma: comparison of cryostat and paraffin wax sections and effect of fixation.

AIMS: To investigate the effects of fixation on the immunohistochemical demonstration of c-erbB-2 oncoprotein using paraffin wax and cryostat sections; to compare c-erbB-2 expression in non-neoplastic and neoplastic gastric tissues. METHODS: Adjacent blocks of tumour and non-neoplastic tissue from four gastrectomy specimens were put into a panel of 10 fixatives including acetone, B5, Bouin's fluid, Carnoy's fluid, buffered formalin, formol dichromate, zinc formalin, 4% paraformaldehyde, periodate-lysine-paraformaldehyde (PLP) and periodate-lysine-paraformaldehyde-dichromate (PLPD) before embedding in paraffin wax for sectioning. Similar tissue blocks were snap frozen and cryostat sections were postfixed in these fixatives, either alone or in combination, before immunostaining. RESULTS: In paraffin wax embedded sections the best fixative was PLP, and in frozen tissues the best results were obtained after fixation of cryostat sections in buffered formalin followed by cold methanol and acetone. Applying these fixatives to samples from a further 16 gastrectomy specimens, strong membrane staining of c-erbB-2 protein was found in the tumour in eight of 16 cases (50%) using paraffin wax sections, and staining was stronger in the better differentiated carcinomas. For frozen tissues, positive membrane staining was found in all gastric adenocarcinomas, but differential staining intensity associated with tumour differentiation could not be detected. CONCLUSIONS: These results indicate that fixation and paraffin wax embedding affect the results of immunohistochemical demonstration of c-erbB-2 in gastric cancer. The choice of fixative is critical in the demonstration and evaluation of c-erbB-2 protein expression by immunohistochemistry in gastric carcinomas. Staining results also vary depending on whether frozen or paraffin wax embedded tissues are studied.

Adenocarcinoma↗

PubMed1978

The effect of chemical fixatives on cell walls of Bacillus subtilis.

Cell walls of Bacillus subtilis were treated with several chemical fixatives which are commonly used preparatory to electron microscopy; i.e., osmium tetroxide, formaldehyde, acrolein, crotonaldehyde, and glutaraldehyde. Dimensional analysis was performed on thin sections of fixed walls from plastic embeddings and, by means of the statistical technique of multiple comparisons, significant differences were found between wall thicknesses from the various fixations. These differences varied with the fixation time and the type of fixative used in the reaction. When compared to embedded walls which had been stained before fixation, the overall effect was a reduction in wall thickness which was attributed to fixative action and not to the embedding or staining processes. The reduction of wall thickness was even more apparent when dimensions of fixed walls were compared to published dimensions of both frozen sections and freeze-etch profiles. Since these fixatives bind to reactive sites within the wall fabric, a change in electrochemical charge density is effected which can be monitored in terms of heavy-metal-binding capacity. Most monoaldehyde fixatives and osmium tetroxide render the wall as reactive, or less reactive, to uranyl acetate as unfixed walls, whereas glutaraldehyde can significantly increase the binding capacity.

Acrolein↗

PubMed2005

Which visual pathways cause fixation-related inhibition?

Visual stimuli can both inhibit and activate motor mechanisms. In one well-known example, the latency of saccadic eye movements is prolonged in the presence of a fixation stimulus, relative to the case in which the fixation stimulus disappears before the target appears. This automatic sensory-motor effect, known as the gap effect or fixation-offset effect, has been associated with inhibitory connections within the superior colliculus (SC). Visual information is provided to the SC and other oculomotor areas, such as the frontal eye fields (FEF), mainly by the magnocellular geniculostriate pathway, and also by the retinotectal pathway. We tested whether signals in these pathways are necessary to create fixation-related inhibition, by using stimuli invisible to them. We found that such stimuli, visible only to short-wave-sensitive cones (S cones), do produce fixation-related inhibition (including when warning effects were equated). We also demonstrate that this fixation-related inhibition cannot be explained by residual activation of luminance pathways and must be caused by a route separate from that of luminance fixation signals. Thus there are at least two routes that cause fixation-related inhibition, and direct sensory input to the SC or FEF by the magnocellular or retinotectal pathways is not required. We discuss the implications that there may be both cortical and collicular mechanisms.

Adolescent↗

PubMed1980

Spatial properties of visual fixation neurons in posterior parietal association cortex of the monkey.

1. A systematic study of the positional selectivity of visual fixation (VF) neurons of the posterior parietal association cortex (area 7a or PG) was made in seven hemispheres of four alert behaving monkeys. By gaze fixation on a small spot of light in space, 125 units were identified as VF neurons. the position of the fixation target was varied not only in the frontal plane, but also in depth. 2. Microelectrode penetrations were made in the anterior and posterior part of area 7a. The recording sites of 104 VF neurons, determined histologically, were distributed mainly in the posterior part: the caudal part of the posterior bank of the intraparietal sulcus and the caudal third of the anterior bank of the superior temporal sulcus. The following conclusions are based mainly on the observations of the VF neurons in the posterior part of area 7a. 3. Most of the VF neurons examined in the frontal plane (86/93) had a preferred direction of gaze along the horizontal (39/86), vertical (38/86), or diagonal axis (9/86), and their discharge rates were monotonic increasing functions of the angle of deviation from the center. 4. Many VF neurons had selectivity in the depth of fixation. The majority (41/63) were activated more intensely when the fixation point was nearer to the animal (less than 50 cm), whereas a considerable number (18/63) were activated better when the fixation point was further from the animal (100 cm or more). There were a few units (4/63) that discharged maximally at intermediate distances. 5. Thirty-two VF neurons were studied in detail along all three axes: vertical, horizontal, and depth. About half of them (17/32) were found to be selective both in the radial direction and the distance of fixation, while the others displayed selectivity in the direction of gaze alone (11/32) or in depth alone (4/32). 6. The activity of VF neurosis in the dark was compared to that in a lighted room in order to examine their relationship to eye position in detail. Half of the VF neurons tested (25/50) showed almost the same discharge rate in the dark as in the lighted room in spite of the absence of visual stimuli other than the target light in the fovea. Moreover, the discharge rate of the majority of these VF neurons displayed a close correlation with eye position, even in complete darkness. On the other hand nearly half of the VF neurons (22/50) showed a decrease in discharge rate in the dark during fixation at preferred positions suggesting that visual stimuli in the surroundings have some excitatory effects on these neurons. There were also some VF neurons whose activity decreased when the target light was interrputed. Even in such visually sensitive VF neurons, their positional selectivity depended mainly on eye position. 7...

Animals↗

PubMed1992

Role of the rostral superior colliculus in active visual fixation and execution of express saccades.

1. In the rostral pole of the monkey superior colliculus (SC) a subset of neurons (fixation cells) discharge tonically when a monkey actively fixates a target spot and pause during the execution of saccadic eye movements. 2. To test whether these fixation cells are necessary for the control of visual fixation and saccade suppression, we artificially inhibited them with a local injection of muscimol, an agonist of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA). After injection of muscimol into the rostral pole of one SC, the monkey was less able to suppress the initiation of saccades. Many unwanted visually guided saccades were initiated less than 100 ms after onset of a peripheral visual stimulus and therefore fell into the range of express saccades. 3. We propose that fixation cells in the rostral SC form part of a fixation system that facilitates active visual fixation and suppresses the initiation of unwanted saccadic eye movements. Express saccades can only occur when activity in this fixation system is reduced.

Animals↗

PubMed1996

Initiation of saccades during fixation or pursuit: evidence in humans for a single mechanism.

1. In four human subjects, we measured the latency of saccadic eye movements made to a second, eccentric target after an initial, foveated target was extinguished. In separate interleaved trails, the targets were either both stationary ("fixation") or both moving with the same velocity ("pursuit"). For both fixation and pursuit trials, we extinguished the first target at randomized times during maintained fixation or pursuit and varied the time interval ("gap duration") before the appearance of the second target. 2. During both fixation and pursuit, the presence of a 200-ms gap reduced the latencies of saccades, compared with those obtained with no gap. For two subjects, we imposed additional, intermediate gap durations and found that saccade latencies varied as a function of gap duration. Furthermore, the latencies of saccades elicited during pursuit displayed the same dependence on gap duration as those elicited during fixation. 3. Our results demonstrate that the "gap effect" observed for saccades made during fixation also occurs for saccades made during pursuit. To the extent that the gap effect on saccade latency reflects a mechanism underlying the release of fixation, our results suggest that the same mechanism is invoked for saccades made during pursuit. From the viewpoint of initiating saccades, the existence of separate fixation and pursuit systems may be irrelevant.

Fixation, Ocular↗

PubMedDate not supplied

Eye fixations predict reading comprehension: the relationships between reading skill, reading speed, and visual inspection.

This experiment addressed the question of whether reading comprehension and speed could be predicted by eye fixations. From a sample of university students who completed tests of reading comprehension and vocabulary, we selected a group of highly skilled readers and a group of less skilled readers. These two groups then read sentences as their eye movements were monitored, with fixation locations and durations recorded. A discriminant function analysis showed that fixation duration was a successful predictor of reading comprehension, but that the number of fixations, regressive fixations, reading speed, and vocabulary were not reliable predictors. A multiple regression analysis revealed that reading speed was predicted by the number of fixations, the average fixation duration, and the duration of the final fixation upon the sentence, but there was no relationship with reading ability. Highly skilled readers are those who can extract information efficiently, but are not necessarily those who have fast overall reading rates.

Adolescent↗

PubMedDate not supplied

Structural properties of six tibial fixation methods for anterior cruciate ligament soft tissue grafts.

This study compared the stiffness (K), yield load (YL), and slippage (SL) of six tibial fixation methods. These properties were determined from load-to-failure and cyclic tests of double-looped tendon grafts fixed to both animal and young human tissue. Tandem washers (K = 259 N/mm, YL = 1159 N, SL = 0.5 mm) and the Washerloc (K = 248 N/mm, YL = 905 N, SL = 2.0 mm) were the two best fixations. At 500 N of load, which is the estimated daily tension of an anterior cruciate ligament graft during intensive rehabilitation, slippage was significantly greater in either of the other two methods for sutures tied to a post (4.9 mm), double staples (3.3 mm), and a 20-mm spiked metal washer (3.5 mm). Interference screw fixation performed well in animal tissue (YL = 776 N), but was significantly worse in young human tissue (YL = 350 N), with 57% of the fixations failing before 500 N of load. Animal tissue should not be used to estimate the performance of interference screw fixation in human tissue. Because 57% of the interference screw fixations using human tissue failed at loads below 500 N, their ability to provide adequate fixation during intensive rehabilitation should be questioned. However, both the Washerloc and tandem washers and screws provide fixation structural properties in young human tibia that should be appropriate for intensive rehabilitation.

Adolescent↗

PubMed2003

Suture-endobutton fixation of ankle tibio-fibular diastasis: a cadaver study.

Suture-Endobutton fixation is proposed as a minimally invasive, flexible fixation of ankle tibio-fibular diastasis, which would not require routine removal. This study tested the Suture-Endobutton construct in a cadaver syndesmosis injury model and compared this against A.O. syndesmosis screw fixation. Sixteen embalmed cadaver legs were used. Phase one consisted of placing the leg in a jig, generating an external rotation torque and measuring diastasis with increasing intraosseous membrane division. Phase two then compared the Suture-Endobutton construct vs. single four-cortex 4.5 mm A.O. screw fixation. Diastasis increased significantly with increasing intraosseous membrane division (p<0.001). No significant differences were seen in the mean rate of failure between the Suture-Endobutton and A.O. screw fixation. However, the Suture-Endobutton did give a significantly more consistent performance; the distribution of standard deviations for A.O. screw fixation was 0.64 mm higher than that for the Endobutton (95% C.I. 0.46 to 0.84). These results show that Suture-Endobutton fixation at least equals the performance of screw fixation and encourages clinical trials in ankle injuries with a syndesmosis diastasis.

Ankle Injuries↗

PubMed1986

Fixation, fine structure, and immunostaining for neuropeptides: perfusion versus immersion of the neuroendocrine hypothalamus.

The effects of various fixatives and fixation methods on ultrastructural morphology and the immunocytochemical localization of beta-endorphin were examined in rat brain. The mediobasal hypothalamus was preserved by vascular perfusion and/or immersion in nine different fixatives. We tested several combinations of paraformaldehyde, glutaraldehyde, acrolein, and picric acid in various isosmolar buffers. Vibratome sections were stained for beta-endorphin employing the peroxidase-antiperoxidase technique, or processed directly for electron microscopy. The ultrastructural quality of a given region was attributed to its location with respect to the blood-brain barrier, the method of fixation, and the concentrations of some of the fixative components. Immersion fixation gave better results and reduced extracellular space in the median eminence (outside the blood-brain barrier) and areas close to the hypothalamic surface. Positive immunostaining of beta-endorphin perikarya occurred only in tissue fixed with periodate-lysine-paraformaldehyde. Light to moderate fiber staining was also present in some paraformaldehyde-glutaraldehyde-acrolein combinations. However, a glutaraldehyde concentration of 1% or higher abolished all positive staining for beta-endorphin. These results emphasize the necessity of optimizing fixation for ultrastructure and for immunocytochemical staining of each individual antigen. The choice of the best fixation method depends not only on the intracellular location of the antigen but also on the relationship between hypothalamic tissue compartments and the blood-brain barrier.

Animals↗

PubMed1987

Fixation, processing, and immunochemical reagent effects on preservation of T-lymphocyte surface membrane antigens in paraffin-embedded tissue.

Fixatives, fixation additives, paraffin processing reagents, and immunochemical reagents were investigated for effects on preservation of T-lymphocyte surface membrane antigens CD3, CD4, and CD8 in human tonsil. Individual reagent effects were assessed in frozen sections by use of monoclonal antibodies and this information was used to optimize T-cell immunostaining in paraffin sections. Harmful factors were fixation delay, fixation at acid pH, fixation and processing at temperatures above 4 degrees C, hot paraffin wax, proteolytic enzymes, methanolic hydrogen peroxide, Triton X-100, and prolonged iodine treatment. Optimal T-cell demonstration in paraffin sections followed tissue fixation in periodate-lysine-paraformaldehyde dichromate at 4 degrees C, pH 7.5; processing through isopropanol, then xylene or chloroform, at 4 degrees C; and embedding in low melting point wax at 45-50 degrees C. Graded antigen stability occurred: CD3 most stable, CD8 least, and CD4 intermediate. CD4 and CD8 antigen preservation in paraffin sections required critical optimal tissue handling. CD3 was more stable and was also demonstrated in tissue fixed in commercial formalin, glutaraldehyde, and Bouin's fluid when fixation and processing conditions were optimized for pH and temperature. Of the fixation additives studied, polyethylene glycol and several potassium and magnesium salts enhanced immunostaining, whereas calcium chloride and lidocaine were deleterious.

Antigens, Differentiation, T-Lymphocyte↗

PubMed1994

Fixation conditions affect the intensity but not the pattern of NADPH-diaphorase staining as a marker for neuronal nitric oxide synthase in rat olfactory bulb.

NADPH-diaphorase (NADPH-d) is commonly used as a histochemical marker for the neuronal form of the enzyme nitric oxide synthase (NOS). A recent biochemical study showed that in broken-cell preparations NADPH-d activity did not fully represent NOS and that NOS-unrelated NADPH-d activity was suppressed during fixation. Because it is unknown whether fixation also affects NOS-associated NADPH-d activity, we investigated the effects of various widely used fixatives on NADPH-d staining in relation to NOS immunoreactivity, obtained with polyclonal antibodies, in rat olfactory bulb. We found that the intensity of NADPH-d staining associated with NOS, as well as that unrelated to NOS, depends on fixation conditions. Addition of glutaraldehyde or lysine/sodium periodate to the fixative decreased intensity of NADPH-d staining. Fixative-dependence of NADPH-d staining was observed not only in the presence of the "normal" co-substrate beta-NADPH but also in the presence of the stereoisomer alpha-NADPH. Unlike the staining intensity, the staining pattern of NOS-associated as well as NOS-unrelated NADPH-d did not change after treatment with various fixatives. Our findings are of considerable practical significance because it has become clear that fixation conditions affect the sensitivity but not the selectively of the NADPH-d reaction as a marker for the presence of NOS.

Amino Acid Oxidoreductases↗

PubMed2002

Hydroxyapatite-coated Schanz pins in external fixators used for distraction osteogenesis : a randomized, controlled trial.

BACKGROUND: Complications of external fixation include loosening of the fixation pins and pin-track infection. Laboratory studies and clinical trials have suggested that hydroxyapatite coating improves the osteointegration of various orthopaedic implants. The purpose of this study was to determine whether the prevalence of pin-related complications can be reduced by the use of hydroxyapatite-coated pins in fixators applied for distraction osteogenesis. METHODS: Forty-six consecutive patients undergoing segmental transport or lengthening of the tibia were randomized to the use of either standard titanium Schanz pins or hydroxyapatite-coated stainless-steel Schanz pins. The fixators were used for an average of thirty-eight weeks (range, fourteen to seventy-two weeks). All patients were closely monitored for pin loosening and infection, and digitized radiographs were assessed for bone resorption around all pins. When the external fixator was removed, the torque required to extract the pins was determined with use of an electronic torque wrench. RESULTS: In the control group (titanium pins), twenty-two pins (13%) loosened and an infection occurred at the site of twenty pins. An extensive infection of the canal developed in one patient. Twenty-two pins were removed or replaced because of these complications. In the hydroxyapatite group, no clinical or radiographic signs of pin loosening or infection were observed and no pins required early removal or exchange. The mean torque (and standard deviation) required to remove the hydroxyapatite-coated pins was 0.43 0.18 N-m compared with 0.10 0.09 N-m for the uncoated pins (p < 0.001). CONCLUSION: Coating pins with hydroxyapatite increases their fixation to bone and reduces the rate of infection and loosening during external fixation for distraction osteogenesis. Use of hydroxyapatite-coated pins should be considered in clinical situations requiring prolonged external fixation.

Adolescent↗