title: Axial preload in external fixator half-pins: a preliminary mechanical study of an experimental bone anchorage system.
abstract: OBJECTIVE
  To demonstrate the effect of axial preload achieved with an experimental external fixator pin prototype on the initial stability of the pin-bone interface.
  
  
  METHODS
  An in vitro mechanical study comparing pin stability of an axially-preloaded experimental pin and a radially-preloaded conventional external fixation pin.
  
  
  BACKGROUND
  The most common problem in clinical practice of external fixation is pin site failure. An experimental external fixator half-pin has been designed introducing axial preload as an alternative method of achieving a stable pin-bone interface.
  
  
  METHODS
  Standardized measurements of pin insertion and removal torque comparing the experimental pin prototype and a conventional external fixator pin in a synthetic composite material and ovine tibial cortical bone.
  
  
  RESULTS
  There is a positive correlation between axial preload and torque resistance of the coaxial experimental half-pin as well as significantly increased torque resistance of the axially-preloaded experimental pin over the conventional pin tested. In addition, significantly lower insertion torque of the experimental pin was observed with the applied insertion technique.
  
  
  CONCLUSIONS
  'Axial preload' achieved with appropriately-designed half pins might represent an effective biology-sparing method of increasing the mechanical stability of the pin-bone interface in unilateral external fixator frames.
  
  
  CONCLUSIONS
  Several aspects of the current external fixator pin design and insertion technique have been implicated for the significant incidence of failure at the pin-bone interface manifested as pin loosening, pin track infection or even osteomyelitis. An axially-preloaded bone fastener system may be mechanically and biologically superior and therefore clinically advantageous.
authors.affiliation: University Department of Orthopaedic Surgery, Bristol Royal Infirmary, UK.
authors.forename: I A
authors.initials: IA
authors.lastname: Karnezis
authors.forename: A W
authors.initials: AW
authors.lastname: Miles
authors.forename: J L
authors.initials: JL
authors.lastname: Cunningham
authors.forename: I D
authors.initials: ID
authors.lastname: Learmonth
mesh_terms: D000818:Animals; D001858:Bone Nails; D016723:Bone Remodeling; D004867:Equipment Design; D004868:Equipment Failure; D016267:External Fixators; D066298:In Vitro Techniques; D012756:Sheep; D013314:Stress, Mechanical; D013977:Tibia / Q000502:physiology* / Q000601:surgery; D019415:Torque