Outcome of limb reconstruction system in tibial infected non-union and open tibial diaphysial fracture with bone loss

Abstract

Introduction:Incidence of open fractures of the long bones is increasing due to the increase in road traffic accidents (RTA) which leads to an increased incidence of complex non-unions of long bones. Patients are usually operated many times for fracture fixation (and healing) or to eradicate infection, which causes soft tissue scarring and devitalization of any surviving bone. Objective: In this study, we assess the outcome of the Limb reconstruction system in tibial infected nonunion and open tibial diaphyseal fracture with bone loss. Method: It is a prospective study conducted on 15 patients and patients included in this study having compound fractures of shaft tibia with bone loss classified by Gustilo-Anderson open fracture classification. With the defect in the distal tibia, proximal corticotomy 1.5 cm distal to the last screw in the proximal clamp and proximal to distal transports were done and vice versa. All patients were evaluated with the ASAMI scoring system into bone results and functional results. Results: In the majority of patients, the injury was caused by road traffic accidents 80% of cases. Out of 15 cases, 2 belong to the upper 3rd, 9 cases belong to the middle 3rd and 4 cases belong to the lower 3rd of shaft tibia. The union time ranges from 4 to 11 months but the maximum union was achieved in 7e9 months in 8 (53.33%). Pin tract infection was reported in two (13.33%) patients who became better with regular dressing. Ankle stiffness was present in one case (6.67%), most probably due to improper physiotherapy. According to ASAMI Criteria excellent radiological results were present in 11 (73.33%) cases, good results were found in 4 (26.67) cases and excellent functional results were observed in 7 cases (46.67%) and good results were found in 8 (53.33%) cases. Infection was cured in all patients and did not recur till the last follow-up. Conclusions: Advantages of rail fixator include less invasive surgery, early weight-bearing, less infection, less blood loss, prevention of diffuse osteoporosis and atrophy, preservation of limb function, no need for bone grafting, correction of deformity during the process of healing, thus no need for a second surgery. Non-union, bone defect, and deformity can be corrected simultaneously. Hence, we recommend the use of this system (rail fixator) especially for infected non-union of long bones and compound fractures with bone loss.

Repetitive brief ischemia accelerates tibial shaft fracture healing: a 5-years prospective preliminary clinical trial (PCT)

“…Two experienced researchers (DW and XBZ) recorded the outcomes. The primary outcome was the bone healing time and bone fracture healing criteria were no pressure pain and longitudinal percussion pain in the fracture area, fuzzy fracture line on X-ray, 3/4 cortical connection and no pain after complete weight-bearing [10,11]. The secondary outcomes were the rates of delayed union and nonunion, the rates of venous thrombosis of lower limbs, Johner-Wruhs scores, Lysholm knee score, VAS scores, postoperative complications, and serum BMP-2, OC and BS-ALP [12,13].…”

Current advancements in therapeutic approaches in orthopedic surgery: a review of recent trends

“…3D printing: 3D printing technology creates customized implants, prosthetics, and surgical guides. These personalized devices improve the fit and function of implants, reduce surgical time, and improve patient outcomes (Sharma et al, 2021).…”

Evolution and Development of Ilizarov Technique in the Treatment of Infected Long Bone Nonunion with or without Bone Defects

“…With the advancement of industrialization and the development of the transportation industry, traffic accidents with high violence and high kinetic energy are frequent, resulting in an increasing number of cases of severe open fracture, which is the most common cause of infected nonunion with or without bone defects, ranging from 4% to 64% 1–3 . Infected nonunion refers to the failure of the fracture healing process and the persistent bone infection at the fracture site for 6–8 months, which is the most challenging category of existing nonunion classification and seriously threatens the limb and life of the patient 3–6 .…”

“…With the advancement of industrialization and the development of the transportation industry, traffic accidents with high violence and high kinetic energy are frequent, resulting in an increasing number of cases of severe open fracture, which is the most common cause of infected nonunion with or without bone defects, ranging from 4% to 64%. 1 , 2 , 3 Infected nonunion refers to the failure of the fracture healing process and the persistent bone infection at the fracture site for 6–8 months, which is the most challenging category of existing nonunion classification and seriously threatens the limb and life of the patient. 3 , 4 , 5 , 6 As a massive challenge in the field of orthopedics, the commonly used methods for clinical treatment of infected bone nonunion and bone defects include large local segment free bone transplantation, bone transplantation with blood vessels, the Masquelet technique, and the Ilizarov technique, etc., both of which are controversial due to iatric autogenous injury.…”