External Fixator Pin Placement in the Lower Extremity Without Fluoroscopy
Bibliographic record
Abstract
INTRODUCTION: External fixation is a critical method for temporizing musculoskeletal injuries. Limited guidance exists on how to achieve appropriate external fixator pin depth without image guidance. We sought to validate a standardized technique for placing external fixation pins in the lower extremity without fluoroscopy. METHODS: Adults undergoing external fixation of lower extremity injuries at a level I trauma center were prospectively enrolled over 12 months. A standardized technique was used for pin placement, and pins were placed by attendings or trainees at PGY2 to PGY6 levels. Complications related to pin placement were recorded and classified as major, potential major, or minor. Major complications included neurovascular injury, pin tract osteomyelitis, and septic arthritis. Potential major complications included soft-tissue pin placement, unicortical pins, deep pin overpenetration (≥26 mm), and pins placed within or near a fracture or joint. Minor complications included pin tract infections and shallow pin overpenetration (9 to 25 mm). "Successful" external fixation application was defined as placement without any major or potential major complications. RESULTS: Thirty-seven constructs (101 pins) were included. A total of 36 constructs (97.3%) and 99 pins (98.0%) were placed successfully. No major complications were observed. Potential complications occurred in one construct (2.7%) in which two pins (2.0%) were placed unicortically. Minor complications occurred in two pins (2.0%) demonstrating shallow overpenetration. Most pins (n = 97; 96%) were placed bicortically without overpenetration. The mean overpenetration of bicortical pins was 3.2 ± 2.3 mm. Overpenetration depth decreased with increasing training levels and increasing experience with the technique. CONCLUSION: Placement of pins without image guidance during external fixation of lower extremity injuries resulted in successful placement of 98% of pins and 97% of constructs. This straightforward, reproducible technique can be used by surgeons of varying skill levels and done to safely apply external fixation in settings that lack fluoroscopic capabilities.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".