Extended use of limb reconstruction system in management of compound tibia diaphyseal fracture as primary and definitive tool
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20174706Keywords:
LRS, Compound tibia, Definitive treatmentAbstract
Background: The fractures of the tibia are among the most difficult fractures to treat effectively. The status of the soft tissues, the degree of comminution and level of contamination sustained at the time of injury affect the long term clinical results. The goal of operative treatment is to obtain anatomic realignment of the shaft of tibia while providing enough stability to allow early motion. This should be accomplished using techniques that minimize osseous and soft tissue devascularization in the hopes of decreasing the complications resulting from treatment.
Methods: A prospective randomized study was conducted between 2014-2016 on 20 patients admitted with compound tibia diaphyseal fracture and treated with Limb reconstruction surgery.
Results: In our study, the mean time of partial weight bearing was 3.5±2.97 weeks, full weight bearing was 8.55± 4.14 weeks and bone union time was 20.22±5.22 weeks. The pin tract infection was found in 5 (25%) cases. Delayed union was observed 06 (30%) cases. Shortening of more than 2 cm were recorded in 3 (15%) patients. Joint (knee or ankle) stiffness was observed in 6 (30%) cases. Loosening of pin was observed in 3 (15%) cases. Chronic osteomyelitis was observed in 3 (15%) cases. Secondary procedures were done in 11 (55%) cases. Bone marrow aspiration was done in 5 (25%) cases, iliac bone grafting in 5 (25%) cases.
Conclusions: LRS is found to be wonderful tool in management of compound tibia fractures as primary and definitive mode because of its safety, versatile nature, patient friendly and cost effectiveness.
References
Praemer A, Furner S, Rice DP. Musculoskeletal conditions in the United States. Park Ridge, Ill: American Academy of Orthopaedic Surgeons; 1992.
Court-Brown CM, Rimmer S, Prakash U, McQueen MM. The epidemiology of open long bone fractures. Injury. 1998;29:529–34.
Whittle PA, Wood II GW. Fractures of lower extremity. 10th ed. In: Campbell’s Operative orthopedics, Canale TS, ed. Philadelphia: Mosby Publications; 2003: 2761-2767.
Harley BJ, Beaupre LA, Jones CA, Dulai SK, Weber DW. The effect of time to definitive treatment on the rate of nonunion and infection in open fractures. J Orthop Trauma. 2002;16:484–90.
Satyanarayana J, Rao TN, Vadlamani KVP, Kiran MC, Moorthy GVS. Management of complex open fractures: A prospective study. J Evol Med Dent Sci. 2015;4(79):13863-78.
Blachut PA, Meek RN, O'Brien PJ. External fixation and delayed intramedullary nailing of open fractures of the tibial shaft. A sequential protocol. J Bone Joint Surg Am. 1990;72(5):729-35.
Reuss BL, Cole JD. Effect of delayed treatment on open tibial shaft fractures. Am J Orthop. 2007;36(4):215-20.
McGraw JM, Lim EV. Treatment of open tibial-shaft fractures. External fixation and secondary intramedullary nailing. J Bone Joint Surg Am. 1988;70(6):900-11.
Maurer DJ, Merkow RL, Gustilo RB. Infection after intramedullary nailing of severe open tibial fractures initially treated with external fixation. J Bone Joint Surg Am. 1989;71(6):835-8.
Padhi NR, Padhi P. Use of external fixators for open tibial injuries in the rural third world: panacea of the poor? Injury. 2007;38(2):150-9.
Mark R. Brinker. Textbook Review of orthopaedic trauma. Second edition. 2013: 143-161.
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.
Piwani M, Bhutto IA, Ahmed I. Evaluation of AO external fixator in the management of open diaphysial fracture of tibia gustilo type IIIA and IIIB. Gomal J Med Sci. 2015;13(1):66-9.
Beltsios M, Savvidou O, Kovanis J, Alexandropoulos P, Papagelopoulos P. External fixation as a primary and definitive treatment for tibial diaphyseal fractures Strategies Trauma Limb Reconstr. 2009;4(2):81–7.
Shikari A, Wani A, Padha K, Bhatti M, Dang H. Fixation Of Compound Fractures Of Distal Tibia Using A Delta External Fixator As A Definite Modality Of Treatment With Or Without Fibular Plating/ Limited Internal Fixation With K- Wires. Int J Orthopedic Surg. 2010;18(2):1-7.
Chandra Prakash Pal et al. Comparative study of the results of compound tibial shaft fractures treated by Ilizarov ring fixators and limb reconstruction system fixators. Chinese J Traumatol. 2015;18:347-51.
Abbas Memon et al. Functional Outcome of Open Diaphyseal Tibial Fracture Treated By A.O Fixation VS N.A Fixation. Medforum 9-article: 64.
Iqbal HJ, Pidikiti P. Treatment of distal tibia metaphyseal fractures; plating versus intramedullary nailing: a systematic review of recent evidence. Foot Ankle Surg. 2013;19(3):143-7.
Tekin AC, Saygılı MS, Adaş M, Çabuk H, Arslan SM, Dedeoğlu SS, et al. Outcome of type 3 open tibial diaphyseal fractures managed with a Limb reconstruction system: analysis of a 49- patient cohort. Med Princ Pract. 2016;25:270-5.
Neto FCJ, Canal MP, Alves BAF, Ferreira PM, Ayres JC, Alves R. Analysis of the characteristics of patients with open tibial fractures of Gustilo and Anderson type III. Rev Bras Ortop. 2016;51(2):143-9.
Patzakis MJ, Wilkins J. Factors influencing infection rate in open fracture wounds. Clin Orthop Res. 1989;243:36–40.
Naique SB, Pearse M, Manachalal J. Management of severe open tibial fractures: The need for combined orthopaedic and plastic surgical treatment in specialist centers. J Bone Joint Surg Br. 2006;88:351–7.
Crowley DJ, Kanaakaris NK, Giannoudis PV. Irrigation of the wounds in open fractures. J Bone Joint Surg Br. 2007;89:580–5.
Hou Z, Irgit K, Strohecker KA, Matzko ME, Wingert NC, DeSantis JG, et al. Delayed flap reconstruction with vacuum-assisted closure management of the open IIIB tibial fracture. J Trauma. 2011;71(6):1705-8.
Steiert AE, Gohritz A, Schreiber TC, Krettek C, Vogt PM. Delayed flap coverage of open extremity fractures after previous vacuum-assisted closure (VAC) therapy: worse or worth? J Plast Reconstr Aesthet Surg. 2009;62:675-83.
Schlatterer DR, Hirschfeld AG, Webb LX. Negative Pressure Wound Therapy in Grade IIIB Tibial Fractures: Fewer Infections and Fewer Flap Procedures? Clin Orthop Relat Res. 2015;473(5):1802–11.
Thakur AJ, Patankar J. Open tibial fractures. Treatment by uniplanar external fixation and early bone grafting. J Bone Joint Surg Br. 1991;73:448-51.
Patil M. Definitive Management of Open Tibia Fractures Using Limb Reconstruction System. J Clin Diagnos Res. 2016;10(7):1-4.
Lakhani A, Singh D, Singh R. Outcome of rail fixator system in reconstructing bone gap. Indian J Orthop. 2014;48:612-6.