Management of complex long bone nonunions using limb reconstruction system

Abstract

Background: Management of complex nonunions is difficult due to the presence of infection, deformities, shortening and multiple surgeries in the past. Complex nonunions are traditionally managed by Ilizarov fixation. The disadvantages of Ilizarov are poor patient compliance, inconvenience of the frame and difficult frame construction. We conducted a study on 30 long bone complex nonunions treated by the limb reconstruction system (LRS).

Materials and methods: Between April 2009 and September 2012, we treated 30 cases of complex nonunion of long bone with the LRS. 28 were male and 2 females. Average shortening was 5.06 cm and 14 cases presented with infected implants. Initially we managed with implant removal, radical debridement followed by fixation with the LRS. In 16 cases, corticotomy and lengthening was done. The average duration of treatment was 9.68 months. We compressed the fracture site at the rate of 0.25 mm per day for 1-2 weeks and distracted the corticotomy at the rate of 1 mm/day till lengthening was achieved.

Result: The union occurred in 89.28% cases and eradication of infection in 91.66% cases. Average lengthening done was 4.57 cm. We had 79% excellent, 11% good and 10% poor bony result and fnctional result was excellent in 40% cases, good in 50% and failure in 10% cases using ASAMI scoring system.

Conclusion: LRS is an alternative to the Ilizarov fixation in their management of complex nonunion of long bones. It is less cumbersome to the patient and more surgeon and patient friendly.

Keywords: Complex nonunion; corticotomy; limb reconstruction system.

Figure 1A

X-ray anteroposterior (a) and lateral (b) view of thigh showing infected nonunion left femur (c) immediate postoperative X-ray showing LRS in place (d, e) followup X-ray showing union (f) clinical photograph showing LRS system in place.

Figure 1B

X-ray anteroposterior (a) and lateral view (b) of thigh at completion of treatment showing fracture has united well (c, d) clinical photographs showing range of motion

Figure 2A

(a, b) Anteroposterior and lateral views of humerus showing infected nonunion left humerus with implant in situ (c) Immediate postoperative anteroposterior X-ray of arm showing LRS in situ (d) Clinical photograph showing LRS in place (e, f) followup X-rays showing union (g) Clinical photograph showing range of motion and implant in situ

Figure 2B

(a, b) Anteroposterior and lateral X-rays shows union (c) Range of motion of elbow after removal of fixator

Figure 3

Anteroposterior (a) and lateral view (b) of leg bones showing infected nonunion left tibia (c, d) anteroposterior and lateral views followup X-rays showing union (e) Clinical photograph showing LRS in place. Patient standing single limb slance. (f) Anteroposterior and lateral X-ray after removal of LRS showing union (g) Clinical photograph showing range of motion

Figure 4

Infected nonunion of right tibia: Preoperative, postoperative, followup and at completion of treatment X-rays

Figure 5

A bar diagram showing preoperative and postoperative limb length discrepancy*