Treatment of infected non union of lower limb long bones with Limb Reconstruction System (LRS).

Dr Mukesh N Shah; Dr Josal S Patel

Volume : VI, Issue : II, February - 2016

Treatment of infected non union of lower limb long bones with Limb Reconstruction System (LRS).

Dr Mukesh N Shah, Dr Josal S Patel

Abstract :

Back ground: Infected nonunion of long bones is very big challenge to manage due to the presence of infection, deformities, shortening and multiple surgeries in the past. Open deidement of the non–union site, appropriate antibiotics and stabilization of fracture are the basic principles of treatment in an infected non–union. Internal fixation of such fracture is fraught with recurrence and or persistence of infection. Infected nonunions are traditionally managed by Ilizarov ring fixator. The disadvantages of Ilizarov are poor patient compliance, inconvenience of the frame and difficult frame construction. Limb reconstruction system provides single stage, easy to construct and less cumbersome option to the patient. We conducted a study on 21 infected nonunions of lower limb long bones treated by the limb reconstruction system (LRS). Materials and Methods: Between January 2011 and December 2015, we treated 21cases of infected nonunion of lower limb long bones with the LRS. 19 were male and 2 females. Average shortening was 4.3 cm and 8 cases presented with infected implants. The average age was 33 years (range 21–55 years). All cases had established nonunion for at least 6 months with evidence of infection. The infection was active in 8 patients and non–draining in 5 patients. Initially we managed with implant removal, radical deidement followed by fixation with the LRS. In 16 cases, corticotomy and lengthening was done. The average duration of treatment was 7.6 months. We compressed the fracture site at the rate of 0.5 mm per day for 2 weeks and distracted the corticotomy at the rate of 1 mm/day till lengthening was achieved. Ilizarov study group ASAMI score was used for bone results and functional results. Complications assessed as per Paley classification. RESULTS: The mean time for union was 5.5 months (4–13 months). The mean follow up after LRS removal was 25.2 months (range 15–44 months). Two cases had angulation of upto 7 degrees (both femur) and remaining cases did not have any angulation. Using ASAMI scoring system functional outcome was excellent in 13(61.9%) patients, good in 6(28.57%) patients & fair & poor result in 1(4.76%) case each. Bone outcome was excellent 14(66.67%) patients, good in 6(28.57%) patients & fair in 1(4.76%) patient. The union occurred in all cases and eradication of infection in 95.35% cases. 3 case required bone grafting out of which 1 case wase initially treated by induced memane technique. Average lengthening done was 3.6 cm. CONCLUSION: “Best treatment for infection is Prevention”. Treatment infected non–union is a long battle. It needs an aggressive approach and a lot of patience from the patient. LRS is an attractive alternative to the Ilizarov fixator in their management of complex nonunion of long bones. It is less cumbersome to the patient and more surgeon and patient friendly