title: Avoidance of external fixation pin induced rotational stiffness in the forearm; a cadaver study of soft tissue displacement relative to the varying position of radius and ulna fixation.
abstract: BACKGROUND
  Stiffness of forearm rotation secondary to transfixion pin sites is a frequent complication of external fixation. Conventional surgical atlases do not consider the effect of rotation on skin displacement and thus do not provide a comprehensive answer. We asked: (1) in what locations in the forearm is soft tissue displacement relative to the ulna and radius least during rotation; (2) in what positions are major neurovascular structures absent; and (3) what maximal range of rotation can be expected in forearm external fixation.
  
  
  METHODS
  Thirty-four matched cadaver arms were used to assess displacement of soft tissues at 10°, 30° and 70° of pronation and supination in relation to a testing frame. The results of these were correlated with positions in which neurovascular structures were absent and deemed insertional "Reference Positions (RP)".
  
  
  RESULTS
  Expected range of rotation in diaphyseal fractures of different levels of both forearm bones was found with RP for the ulna occurring along the length of the forearm. Reference positions for the radius which provide full forearm rotation are situated only in the distal third; positions which provide partial rotation are located in the proximal and middle third.
  
  
  CONCLUSIONS
  Full range of rotation may be maintained in the case of isolated external fixation of ulnar diaphyseal fractures. In isolated external fixation of the radius a reduced range of forearm rotation may be expected.
authors.affiliation: Vreden Russian Research Institute of Traumatology and Orthopedics 8 Baykova Str. St. Petersburg 195427 Russia.
authors.forename: Pavel Nikolaevich
authors.initials: PN
authors.lastname: Kulesh
authors.affiliation: Dawson Creek and District Hospital 11100-13th Street Dawson Creek BC V1G 3W8 Canada.
authors.forename: Matt D A
authors.initials: MD
authors.lastname: Fletcher
authors.affiliation: Vreden Russian Research Institute of Traumatology and Orthopedics 8 Baykova Str. St. Petersburg 195427 Russia ; St. Petersburg State University Universitetskaya 7-9 St. Petersburg 199034 Russia.
authors.forename: Leonid N
authors.initials: LN
authors.lastname: Solomin
keywords: External fixation; Forearm rotation; Rotation stiffness; Transfixion pin-induced stiffness; Transosseus osteosynthesis