Small smooth or threaded percutaneous pins (Fig 272I10) are often used in the small bones of the hand or foot to add stability while fracture union occurs. The hand and foot possess an excellent blood supply, which usually results in early union. The pins are cut off outside the skin so that they may be removed between 3 and 9 weeks postoperatively.
Internal cerclage wires are often used to hold structures that have fractured under tension. Examples are tuberosity fractures of the proximal humerus ( Fig. .272-H) or patella fractures. Cerclage wires may also be used with or without a plate to stabilize a fracture around a prosthetic joint implant ( .Fig.,..2Z2:1.2). They serve the same role as a screw, which cannot be placed through the implant.
FIG. 272-11. A. and B. This olecranon fracture was stabilized with two smooth pins and a cerclage wire, which allowed joint motion during healing.
FIG. 272-12. A. and B. This periprosthetic fracture is stabilized by a special plate designed for use with wires or screws.
COMPLICATIONS As with external fixation pins, the most common complication of using percutaneous pins is pin-tract infection. Such infections can be treated by removing the pin, but this should only be done after consultation with an orthopedist. A course of oral antibiotics may also be indicated. Complications of cerclage wires include wire breakage prior to union or perforation of a wire through thin overlying skin.
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