Establishing the efficacy of limb reconstruction system (LRS) in the management of complex long bone non- union: A prospective study

Author(s): Dr. Nirup NC and Dr. Venkatachalam K

Abstract: In an urban metropolitan city like Chennai, over the years there has been a steady increase of high velocity RTA’s especially with the number of citizens using two wheelers. In these instances, it is common to encounter communited open long bone fractures of the humerus, tibia and femur. Despite the prompt redressal of these cases with adequate debribment and stabilisation, a significant percentage of these cases land up with recrudescence of infection leading to complex non-unions. Some of these cases end up being operated upon several times with an aim to eradicate the infection, the presence of infection leads to scaring of sub adjacent soft tissue and the repetitive surgical intervention leads to devitalisation of the surviving bone. These complex infective non-union presents with not only with problem of indolent infection but with associated deformity, limb length discrepancy, sub adjacent joint involvement, disuse osteoporosis and soft tissue atrophy, as a consequence they turn out to be a complex challenging orthopaedic situation. These complex non-unions have been over the decades been traditionally addressed by the ilizarov ring fixator systems. In comparison limb reconstruction system which are lighter, less cumbersome and structurally rigid and uniplanar, come in as a significantly suitable alternative. It further has the advantage of distraction at one level and compression at fracture site. It permits dynamization of fracture site which is an essential element in the treatment of any non-union. In this prospective case series done between March 2015 to October 2017, we have studied 34 cases of patients reporting with complex long bone non-unions by the application of limb reconstruction system. The present study establishes the efficacy of the limb reconstruction system (LRS) in the treatment of these complex non-unions fractures of the long bone. In our series all cases went in for sound union with only 5.72% (n = 4) requiring resurgery.

DOI: https://doi.org/10.22271/ortho.2018.v4.i2h.79