Infected Nonunion of Tibia Managed by Limb Reconstruction System- A Prospective Cohort Study RC01-RC04
Dr. Sanjiv Kumar,
Department of Orthopaedic Surgery, RALC Buliding, KGMU, Lucknow-226003, Uttar Pradesh, India.
Introduction: Infected nonunion of tibia is one of the most commonly faced problem in both compound as well as closed fractures of Tibia, treated surgically. Few patients also present with gap at the fracture site which may be either due to bone loss during trauma or due to debridement of dead bone during previous surgeries. Treatment of infected nonunion is always challenging with unpredictable outcomes. Limb Reconstruction System (LRS) is one of the systems available to treat this complex situation.
Aim: To evaluate the role of LRS in treatment of infected nonunion of Tibia in terms of union time, total duration of fixator applied and Visual Analouge Score (VAS).
Materials and Methods: Twenty one patients of infected gap, nonunion of tibia were included in the study and were treated with debridement, resection of dead bone and application of LRS and segment transport. The results were evaluated in terms of union time, total duration of fixator applied and VAS. Bony and functional assessment was done by Association for the Study and Application of the Methods of Illizarov (ASAMI) criteria. SPSS statistics 24.0 was used for analysis. Mean, median and mode were used to describe continuous variable.
Results: Out of 21 patients, 19 were males and two were females. The mean age of patients was 29.43±14.07 years. The mean limb length discrepancy was 23.3 mm (range, 15-40 mm). The mean duration from injury to LRS application was 7.9 months (range, 6-12 months). Mean duration of follow-up was 29.5 months (range, 16-50 months). Average union time was 44 weeks and average fixator time was 11.2 months. Bony and function results were good and excellent in 90% cases.
Conclusion: The use of monolateral rail external fixator LRS is an effective method for the treatment of infected nonunion of tibia augmented with a fibular strut graft. This provides good results in terms of bony union, subsidence of infection and functional results.