Hi, this is Mike Swords, I'll be reporting on our study looking at ankle temporizing external fixation as a risk factor for sharp exposure, a common occurrence. As we all know, external fixation is a common initial strategy for many complex ankle and high foot injuries. It's often performed prior to transfer to a surgeon of higher volume or an institute better suited to manage these definitively. The purpose of our study was to evaluate frame constructs for risk of sharp exposure to the healthcare team when patients were received and transferred from an outside institution after external fixation had been applied. We looked at patients with an external fixer applied prior to transfer to myself over a three-year period. We evaluated the frame constructs for sharp pin ends. These sharp pin ends could occur one of two ways, either the pin was cut in a manner that resulted in a sharp pin end or failing to cut the leading sharp end of an external fixation pin. We classified these pins both on the anatomic location as either tibia, foot, or calcaneal, as well as by the type of pin, either a monolateral or transcalcaneal pin. In all, we had 39 patients over a three-year period which were accepted and transferred with external fixation applied prior to transfer. 16 of 39 external fixation constructs had a sharp pin end presenting risk for potential of injury at the receiving institution. Of the 16 frames with sharp pin ends, two were tibia pins and 14 were transcalcaneal pins. When we looked at the tibia pins, both were the result of cutting the pin in a manner that resulted in a sharp, jagged pin end, which results from using a cutter similar to the one seen on the right side of this slide. When we looked at the 14 transcalcaneal pins, these were all cases where the leading sharp pin end that was driven through the calcaneus was not cut off after insertion. As you can see examples of on the right side of the screen, there were no cases of foot pins or monolateral calcaneal pins with sharp ends. In conclusion, external fixation plays an important role in stage management of complex ankle and high foot trauma, and all external fixation pins should be cut in a manner that results in blunt pin ends. Pin cutters that result in blunt pin ends are commercially available and should be used to prevent potential for sharp injury in all external fixation cases. Thank you.

Mike Swords

ankle temporizing external fixation

sharp exposure

frame constructs

sharp pin ends