External hinged fixation vs. internal joint stabilization for elbow instability: a systematic review and meta-analysis of functional outcomes and surgical complications.

Importantly, our findings expand upon the work of Heifner et al, 14 who systematically compared device-related complications between IJS and HEF and observed higher rates of pin-site infections, construct failure, and recurrent instability with HEF, though these differences did not reach statistical significance. 12 Their study highlights that the complication burden of HEF is predominantly driven by the presence and mechanics of the external hardware rather than risks inherent to the surgical implantation itself.

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