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The proximal pin is 1 2 cm anterior to the distal one.
The most proximal pin (5) is unicortical but a hydroxyapatite-coated screw is used to ensure satisfactory bone hold.
When the Orthofix monorail was employed anteriorly, the most proximal pin was inserted in the distal diaphysis of the femur ensuring central placement in the sagittal plane.
The first (type V) was probably due to a proximal pin site infection from the temporary external fixator and was treated by removal of the device and substitution with an antibiotic-embedded cement spacer.
The most frequently occurring complications were minor pin tract infection in six patients, deep infection in two patients, and 32 patients suffered excessive granulation tissue formation mostly around the proximal pin.
Also, two patients (2.9%) developed bone infection at the site of entry of the proximal pin in the lateral cortex with a sinus discharging pus that does not respond to antibiotics given according to the culture taken from the sinus; these patients responded to debridement and curettage of the bone through lateral approach.
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Removal of some of the most proximal pins (those fixing the proximal osteotomy) once it shows signs of satisfactory healing.
Nearly all patients had pin site issues especially in the proximal pins which settled with pin site care and oral antibiotics and a few had local antibiotic injections.
Distal pins were inserted into the second metacarpal bone and proximal pins into the radius shaft Open image in new window Fig. 3 Axial plane CT imaging after emergency surgery.
That is why we resort to a protocol of gradual frame disassembly; Removal of some of the most proximal pins (those fixing the proximal osteotomy) once it shows signs of satisfactory healing.
Its placement started with the installation of two proximal pins.
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