Outcomes of mono-lateral limb reconstruction system in infected non-union of long bones
Keywords:Non-union, Infection, Long bones, Limb reconstruction system, External fixator
Background: We planned to evaluate functional and radiological outcomes of mono-lateral limb reconstruction system for infected non-union of long bones and to analyse its complications occurring.
Methods: It was a prospective study, conducted during period of September 2015 to August 2017 and consisted of 73 cases of these 60 cases were available for final assessment. This infected non-union were classified by AO classification and were treated with mono lateral limb reconstruction system. All the cases were evaluated by ASAMI criteria for bony and functional outcomes. Our mean follow up period was 16.8 months.
Results: Among 60 cases of infected non-union with mono-lateral external fixator were followed for mean 16.8 months. According to these ASAMI criteria in our study 26.6% had excellent; 46.6% had good; 16.6% fair; and 10% poor bony outcome. And the functional outcomes were 13.3%, 60%, 16.6%, 10% were excellent, good, fair and poor respectively. Among the cases 50% had pin tract infections and loosening. Two cases pin revision was done. Sinus tract got cleared in all cases except 6 where multiple sinus tracts were present and healing did not occur. There were no infections at the corticotomy site. Delay in the consolidation phase was present in all cases. There was no difficulty in transportation of bone. Post-operatively wound dehiscence in eight cases was managed with split skin graft cover. Limb length discrepancy upto 2.5 cms in lower limb was managed with modified footwear with heel and sole raise. Non-healing fractures united in mean 5.9 months after start of treatment. Non-union site united in 90% cases. Conclusions: Mono-lateral limb reconstruction system is efficient method for treatment of infected non-union of long bones. It has an additional advantage of correcting limb length discrepancies which sometimes occur during the course of treatment.
Keywords: Non-union, Infection, Long bones, Limb reconstruction system, External fixator
Campbell’s operative orthopaedics. 10th edition. 2002: 2706-2714.
Mahaluxmivala J, Nadarajah R, Allen PW, Hill RA. Ilizarov external fixator: acute shortening and lengthening versus bone transport in the management of tibial non-unions. Injury. 2005;36(5):662-8.
Megas P. Classification of nonunion. Injury. 2006;37(9):927.
Ong CT, Choon DS, Cabrera NP, Maffulli N. The treatment of open tibial fractures and of tibial non-union with a novel external fixator. Injury. 2002;33(9):829-34.
Melendez E, Colon C. Treatment of open tibial fractures with the orthofix fixator. Clin Orthop. 1989;241:224-30.
Chapman’s orthopaedic surgery. 3rd edition. Chapter 26. 2001.
Ruedi T, Murphy W. AO Principles of fracture management. 2000.
Jain A, Sinha S. Infected nonunion of long bones. Clin Orthop Relat Res. 2005;431:57-65.
Dendrinos GK, Kontos S, Lyritsis E. Use of the Ilizarov technique for Treatment of nonunion of the tibia associated with infection. J Bone Joint Surg Am. 1995;77(6):835-46.
Haidukewych G, Sperling J. Results of treatment of infected Humeral Nonunions the Mayo clinic experience. Clin Orthop Relat Res. 2003;414:25-30.
A.S.A.M.I group. Operative principles of Ilizarov. 1991.
Patzakis MJ, Scilaris TA, Chon J, Holtom P, Sherman R. Results of bone grafting for infected tibial nonunion. Clin Orthop Relat Res. 1995;315:192-8.
Sangkaew C. Distraction osteogenesis for the treatment of post traumatic complications using a conventinal external fixator. A novel technique. Injury. 2005;36(1):185-93.
Kelly P. Infected nonunion of the femur and tibia. Orthop Clin North Am. 1984;15(3):481-90.
Chantelot C, Robert G, Aihonnou T, Gueguen G, Migaud H, Fontaine C. Role of external fixators for treatment of humeral fractures: report of 23 cases using Orthofix fixators. Chir Main. 2002;21(2):134-9.
Guidera K, Hess W, Highhouse KP, Ogden JA. Extremity lengthening: results and complications with the Orthofix system. J Pediatr Orthop. 1991;11:90-4.
Dahl M, Gulli B, Berg T. Complications of limb lengthening a learning curve. Clin Orthop Relat Res. 1994;301:10-8.
García-Cimbrelo E, Martí-González JC. Circular external fixation in tibial Nonunions. Clin Orthop Relat Res. 2004;419:65-70.
Biasibetti A, Aloj D, Di Gregorio G, Massè A, Salomone C. Mechanical and biological treatment of long Bone nonunion. Injury. 2005;36(4):45-50.
Gopal S, Majumder S, Batchelor AG, Knight SL, De Boer P, Smith RM. Fix and flap: the radical orthopaedic and plastic treatment of severe open fractures of the tibia. J Bone Joint Surg Br. 2000;82(7):959-66.
Guadrini G, Pascarella R, Colozza A, Stagni C. Infected nonunion of the humerus. Chir Degli Organi Di Movi. 2000;85:251-5.