Intramedullary Pin (IM Pin) Specification, Uses, Sizes and Surgical Techniques.

Steinmann Pins

Intramedullary Pin (IM Pin) Specification

Intramedullary Pin (IM Pin) insertion remains the most commonly performed procedure in orthopedic practice. Although its use for definitive fracture treatment has steadily declined due to advent of newer implants and devices, it still finds application in treatment in fractures suffered by medically unfit and pediatric patients and for providing interim traction in almost all lower limb injuries as well as hip and knee pathologies.

Intramedullary Pin (IM Pin) is composed of biocompatible materials such as stainless steel. They are smooth and cylindrical, with a sharp tip on one end and a hole or groove on the other.

Intramedullary Pin (IM Pin) Sizes

Intramedullary Pin (IM Pin) is a thin metal rod commonly used in orthopedic procedures for holding large bone fractures together. These pins function similarly to K Wire, but are larger in diameter.

Steinmann Pins are available in various Types, lengths and diameters.
Types: Single Trocar, Double Trocar, Single Trocar Threaded, Trocar & Threaded, Centre Threaded
Diameters: 1mm, 2mm, 2.5mm, 3mm, 3.5mm, 4mm, 4.5mm, 5mm, 5.5mm, 6mm, 6.5mm, 7mm and 8mm
Lengths: 100 mm to 300 mm

Intramedullary Pin (IM Pin) Indications for Use

Intramedullary Pin (IM Pin) is indicated for use in the fixation of bone fractures, bone reconstruction, and as guide pins for insertion of other implant. The size of the Pin chosen should be adapted to the specific indication. Surgeon judgement is required to ensure a Pin is appropriate for the indication. There is a potential risk of Pin migration in some fracture fixation applications such as the clavicle.

Intramedullary Pin (IM Pin) indicated for use only in the following conditions:

Bone trauma requiring internal fixation for healing.
Fixation of soft tissue to bone where Pins are able to so do safely.
Bone lengthening and shortening procedures.
Osteotomies and other realignment procedures.

The Intramedullary Pin (IM Pin) is placed into the bone during a surgical operation using a pre-drilled hole. The pointed tip makes it easier to penetrate the bone, while the hole or groove on the other end allows for the attachment of external fixation devices such as traction devices or external fixators.

Depending on the surgical application, Intramedullary Pin (IM Pin) might be either temporary or permanent implants. Temporary pins are usually removed once the bone has healed and stabilised, whereas permanent pins can be maintained in place indefinitely.

Upper tibial Steinman pin insertion is required for most fractures around the hip joint and the femur. The insertion of a Steinman pin is a relatively safe procedure if the basic principles of insertion are adhered to. Complications like infection and pin loosening are quite common especially if the pins are retained for longer duration, which is rarely the scenario these days. Besides other complications like damage to ligaments & growth plate, pin cut through, major complications do occur like deep peroneal nerve palsy leading to foot drop, growth plate damage in children and pseudoaneurysm of anterior tibial artery.

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Intramedullary Pin (IM Pin) Contraindications

Contraindications may be qualified or total, and need to be taken into consideration when evaluating the prognosis in each case. The physician’s education, training and professional judgement must be relied upon to choose the most appropriate device and treatment. Conditions presenting an increased risk of failure include:

Any active or suspected latent infection or marked local inflammation in or about the affected area.
Compromised vascularity that would inhibit adequate blood supply to the fracture or the operative site.
Bone stock compromised by disease, infection or prior implantation that can not provide adequate support and/or fixation of the devices.
Material sensitivity, documented or suspected.
Obesity. An overweight or obese patient can produce loads on the implant that can lead to failure of the fixation of the device or to
failure of the device itself.
Patients having inadequate tissue coverage over the operative site.
Implant utilization that would interfere with anatomical structures or physiological performance.
Any mental or neuromuscular disorder which would create an unacceptable risk of fixation failure or complications in postoperative care.
Other medical or surgical conditions which would preclude the potential benefit of surgery.
All associated diseases which could endanger the function and success of the Intramedullary Pin (IM Pin).

Warnings and Precautionary for Intramedullary Pin (IM Pin)

Before using Intramedullary Pin (IM Pin), the surgeon and ancillary staff should study the safety information in these instructions, as well as any product-specific information in the product description, surgical procedures and/or brochures.

Pin is made from medical grade materials and are designed, constructed and produced with utmost care. These quality Pin assure best working results provided they are used in the proper manner. Therefore, the following instructions for use and safety recommendations must be observed.

Improper use of Pin can lead to damage to the tissue, premature wear, destruction of the instruments and injury to the operator, patients or other persons.

It is vital for the operating surgeon to take an active role in the medical management of their patients. The surgeon should thoroughly understand all aspects of the surgical procedure and instruments including their limitations. Care in appropriate selection and proper use of surgical instruments is the responsibility of the surgeon and the surgical team. Adequate surgical training should be completed before use of implants.

Factors which could impair the success of the operation:

Allergies to implanted materials.
Localized bone tumours.
Osteoporosis or osteomalacia.
System disease and metabolic disturbances.
Alcohol and drug abuse.
Physical activities involving excessive shocks, whereby the implant is exposed to blows and/or excessive loading.
Patients who are mentally unable to understand and comply with the doctor’s instructions.
Poor general health.

Possible Adverse Effects

The following adverse effects are the most common resulting from implantation:

Loosening of the Pin, which may result from cyclic loading of the fixation site and/or tissue reaction of the implant.
Early and late infection.
Further bone fracture resulting from unusual stress or weakened bone substance.
Temporary or chronic neural damage resulting from pressure or hematomata.
Wound hematomas and delayed wound healing.
Vascular disease including venal thrombosis, pulmonary embolism and cardiac arrest.
Heterotopic ossification.
Pain and discomfort due to presence of the Intramedullary Pin (IM Pin).
Mechanical failure of the implant, including bending, loosening or breakage.
Migration of implant resulting in injury.

Preoperative Planning for Intramedullary Pin (IM Pin)

The operating planning is carried out following a thorough clinical evaluation of the patient, Also, x-rays must be taken to allow a clear indication of the bony anatomy and associated deformities. At the time of the operation, the corresponding implantation instruments in addition to a complete size of Intramedullary Pin (IM Pin) must be available.

The clinician should discuss with the patient the possible risks and complications associated with the use of implants. It is important to determine pre-operatively whether the patient is allergic to any of the implant materials. Also, the patient needs to be informed that the performance of the device cannot be guaranteed as complications can affect the life expectancy of the device.

Intramedullary Pin (IM Pin) Precautions

Confirm functionality of instruments and check for wear during reprocessing. Replace worn or damaged instruments prior to use.
It is recommended to use the instruments identified for this Pin.
Handle devices with care and dispose worn bone cutting instruments in a sharps container.
Always irrigate and apply suction for removal of debris potentially generated during implantation or removal.

Intramedullary Pin (IM Pin) Warnings

Intramedullary Pin (IM Pin) can break during use (when subjected to excessive forces). While the surgeon must make the final decision on removal of the broken part based on associated risk in doing so, we recommend that whenever possible and practical for the individual patient, the broken part should be removed. Be aware that implants are not as strong as native bone. Implants subjected to substantial loads may fail.
Instruments, screws and cut plates may have sharp edges or moving joints that may pinch or tear user’s glove or skin.
Take care to remove all fragments that are not fixated during the surgery.
While the surgeon must make the final decision on implant removal, we recommend that whenever possible and practical for the individual patient, fixation devices should be removed once their service as an aid to healing is accomplished. Pin removal should be followed by adequate post-operative management to avoid refracture.

Intramedullary Pin (IM Pin) General Adverse Events

As with all major surgical procedures, risks, side effects and adverse events can occur. While many possible reactions may occur, some of the most common include: Problems resulting from anesthesia and patient positioning (e.g. nausea, vomiting, dental injuries, neurological impairments, etc.), thrombosis, embolism, infection, nerve and/or tooth root damage or injury of other critical structures including blood vessels, excessive bleeding, damage to soft tissues incl. swelling, abnormal scar formation, functional impairment of the musculoskeletal system, pain, discomfort or abnormal sensation due to the presence of the device, allergy or hypersensitivity reactions, side effects associated with hardware prominence, loosening, bending, or breakage of the device, mal-union, non-union or delayed union which may lead to breakage of the Intramedullary Pin (IM Pin), reoperation.

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Intramedullary Pin (IM Pin) Specification, Uses, Sizes and Surgical Techniques.