Study of limb reconstruction system in infected and gap nonunion: At tertiary care centre

Abstract

Background: Management of nonunion with bone loss of long bones is a matter of debate. The treatment options range from external fixator, Masquelet technique, nailing, ring fixator, bone grafting with or without plastic reconstruction. All the procedures have their own set of complications like acute docking problems, shortening, difficulty in soft tissue management, chronic infection, increased morbidity, multiple surgeries, longer hospital stay, malunion, nonunion and higher patient dissatisfaction. We evaluated the outcome of the limb reconstruction system (LRS) in the treatment of infected non union and bone loss of long bones as a definitive mode of treatment to achieve union as well as eradication of simultaneously. Aim: The aim of the study is to analyze the outcome of treatment of Infected and Gap Nonunion of long bones by using Limb Reconstruction System (The dynamic external fixation system and Rail fixation system) and reveal its real usefulness. Method and Materials: In this study, we included 21cases of infected non-union with age range from 16 yrs to 65 yrs (with a mean age of 37.5 yrs) of which 19 males (90.47%) and 2 females (9.53%) using AO classification for infected nonunion categorized them into Infected non-draining nonunion (Active/Quiescent) and Infected draining nonunion treated them with limb reconstruction system (LRS). Results: Results were analyzed as per the ASAMI criteria (Association for the Study and Application of Methods of Illizarov) and complications as per Paley's classification. Of the 21patients union achieved in 18 patients (85.7%). Union time ranged from 4 to 9 months (mean 5.9months). Sinus tract got cleared in all cases except 3 where the sinus tracts were multiple and there was no progression towards union in those three cases. Out of 21 cases 11 cases had pin tract infection (52.3%) which was most common problem in this study. Conclusion: The limb reconstruction system is uniplanar and less bulky. Use of limb reconstruction system is convenient and effective method for the treatment of infected and gap nonunion of long bones. This can also be used to correct the limb length discrepancies simultaneously.