Limb reconstruction system as a primary and definitive mode of fixation in open fractures of long bones

Abhijit Bhimrao Kale, Vivek Vishwanath Patole, Harshad Ganesh Argekar, Sudhir Sharan, Arvind Balkrishna Goregaonkar


Background: Management of open fractures of long bones by the traditional systems is very complex. Limb reconstruction system (LRS) was considered as very effective, and offers rigid stabilization of fracture fragments and with an easy access to soft tissue care. The aim of the study was to determine the efficacy of LRS for treatment of open fractures of long bones.

Methods: This prospective study included 30 cases of both the sexes aged between 11-60 years. Patients with closed fractures of long bones and fractures treated conservatively were excluded from the study. Their clinical and radiological evaluation will be done at presentation and certain specific intervals and evaluated for signs of bone union and associated complications.

Results: The mean age of the patients participated in the study was 35.6 years with male predominance (93.3%). All patients (100%) were injured by road traffic accidents. 50% of the cases were of Grade 2 type of fractures. The most common complication encountered was pin tract infections seen in 8 cases. We had good results in 24 patients, moderate in 5 and poor in 1 patient using modified Anderson and Hutchinson’s criteria.

Conclusions: LRS is an alternative to the traditional system of fixation in the primary management of open fractures of long bones. It is less cumbersome to the patient and more patient friendly in terms of reducing financial burden also. It is a definitive single stage procedure.



Open fractures, Long bones, Limb reconstruction system

Full Text:



Dendrinos GK, Konto S, Lyritsis E. Use of Ilizarov technique for treatment of nonunion of tibia associated with infection. J Bone Joint Surg Br. 1995;77:835–46.

Motsitsi NS. Management of infected nonunion of long bone: The last decade (1996-2006). Injury. 2008;39:155–60.

Royston S. Management of nonunion of fractures by distraction with correction of angulation and shortening. J Bone Joint Surg Br. 1996;78:105–9.

Saleh RA. Bifocal surgery for deformity and bone loss after lower limb fracture. J Bone Joint Surg Br. 1995;77:429–34.

Paley D. Problems, Obstacles and complications of limb lengthening by the Ilizarov technique. Clin Orthop Relat Res. 1990;250:81–104.

Watson TJ. Principles of External Fixation. In: Rockwood and Green's fracture in adults. Chapter 8, Volume 1. 7th edition. Philladelphia, USA: Lippincott Williams and Wilkins Publisher; 2010: 191–243.

Anderson LD, Hutchins WC, Wright PE, Disney JM. Fractures of the tibia and fibula treated by casts and transfixing pins. Clin Orthop. 1974;105:179–91.

Azar FM, Canale ST, Beaty JH. Fractures and dislocations in adults. In: Campbell's Operative Orthopaedics. Volume 3. 11 th edition. Philadelhia: Mosby; 2008: 2662.

Thakur AJ, Patankar J. Open tibial fractures. Treatment by uniplanar external fixation and early bone grafting. J Bone Joint Surg.1991;73(3):448-51.

Antich-Adrover P, Marti Garin D, Maurias-Alvarez J, Puente-Alfonso C. External fixation and secondary intramedullary nailing of open tibial fracture-A randomized prospective trial. JBJS. 1997;79(3):433-7.

Granhed HP, Karladani AH. Bone debridement and limb lengthening in type III open tibial shaft fractures. Acta Orthop Scan. 2001;72(1):46-52.

Paley D, Catagni MA, Argnani F, Villa A, Benedetti GB, Cattaneo R. Ilizarov treatment of tibial nonunions with bone loss. Clin Orthop Relat Res. 1989;241:146–65.

Tornetta P, Bergman M, Watnik N. Treatment of grade 3b open tibial fractures. J Bone Joint Surg. 1994;76:13

Robert Rozbruch S, Weitzman AM, Tracey Watson J, Freudigman P, Katz HV, Ilizarov S. Simultaneous treatment of tibial bone and soft-tissue defects with the Ilizarov method. J Orthop Trauma. 2006;20:197–205.

Sen C, Kocaoglu M, Eralp L, Gulsen M, Cinar M. Bifocal compression-distraction in the acute treatment of grade III open tibia fractures with bone and soft-tissue loss: A report of 24 cases. J Orthop Trauma. 2004;18:150–7.

Mekhail AO, Abraham E, Gruber B, Gonzalez M. Bone transport in the management of posttraumatic bone defects in the lower extremity. J Trauma. 2004;56:368–78.

Bumbasirevic M, Tomic S, Lesic A, Milosevic I, Atkinson HD. War-related infected tibial nonunion with bone and soft-tissue loss treated with bone transport using the Ilizarov method. Arch Orthop Trauma Surg. 2010;130:739–49.

Donnan LT, Saleh M, Rigby AS, McAndrew A. Radiographic assessment of bone formation in tibia during distraction osteogenesis. J Pediatr Orthop. 2002;22:645–51.

Wani N, Baba A, Kangoo K, Mir M. Role of early Ilizarov ring fixator in the definitive management of type II, IIIA and IIIB open tibial shaft fractures. Int Orthop. 2011;35:915–23.

Atef A, El-Tantawy A. Management of open infected comminuted tibial fractures using Ilizarov concept. Eur J Orthop Surg Traumatol. 2014;24:403–8.

Ajmera A, Verma A, Agrawal M, Jain S, Mukherjee A. Outcome of limb reconstruction system in open tibial diaphyseal fractures. Indian J Orthop. 2015;49(4):429–35.

Patil MY, Gupta SM, Chaitanya Kurupati SK, Agarwal S, Chandarana V. Definitive Management of Open Tibia Fractures Using Limb Reconstruction System. J Clin Diag Res. 2016;10(7):1-4.