Abstract
Introduction
Indications for the use of external fixation include damage control orthopaedics, definitive fracture treatment, deformity correction and leg lengthening. Despite many advances in the development of external fixation techniques, pin-tract infection and loosening are still significant complications. They are the most commonly occurring complications during limb lengthening using external fixation, with some studies reporting an incidence of up to 80%.
Objectives
The main aim of this systematic review was to investigate HA-coated versus uncoated external fixator pins used in patients undergoing leg lengthening and determine benefits in terms of pin loosening, infection and loss of reduction/malunion.
Methods
A systematic literature search of MEDLINE (PubMed), EMBASE and Cochrane library databases was undertaken. Comparative trials investigating HA-coated versus uncoated external fixation pins used in patients undergoing leg lengthening procedures were identified. These were critically appraised as per the CASP (Guyatt et al) and CONSORT guidelines (Schulz et al., 2010). Primary outcome measures included pin loosening and infection. Secondary outcome measures included loss of reduction/malunion.
Results
All studies identified had different criteria for defining pin loosening and infection. However, they all demonstrated a statistically significant reduction in loosening with HA-coated pins. Review of the studies included demonstrated insufficient evidence to determine any significant clinical benefit with regards to infection and malunion. Critical appraisal demonstrated average methodological quality of the studies.
Conclusion
HA-coating of external fixator pins improves bone fixation and reduces loosening in patients undergoing leg lengthening procedures, but the influence on infection and malunion is not clear.
