INTRODUCTION: Management of the complex non union of tibia is a challenging task due to infection, bony gap, deformity, poor bone quality and poor soft tissue cover at fracture site. The limb reconstruction system (LRS) or Rail fixator has emerged as a viable option for the treatment of the same as it can address most of all above problems. It is more patient friendly and easier to apply in comparison to Ilizarov ring fixator. MATERIAL AND METHODS: Twenty two patients (17 males and 5 females) with complex non union of tibia underwent thorough debridement and resection of non viable bone followed by bone transport to fill the gap and then lengthening (8 patients) or acute docking & lengthening (14 patients) by the use of rail fixator. The average time to union, bone gap filled, lengthening achieved, treatment index were measured. The bone and functional outcome assessment was done by ASAMI score. The complications were classified according to Paley's classification. RESULTS: Union without residual infection was achieved in 20 (90.1%) patients while 2 patients had failure. As per ASAMI criteria bone results were excellent in 12 (54.5%), good in 5 (22.7%), fair in 3 (13.6%) and poor in 2 (9.1%). Functional results were excellent in 11 (50%), good in 5 (22.72%), fair in 4 (18.18%) and failure in 2 (9%). Mean treatment duration was 8.2 months (range 7-19 months). Mean follow up duration was 11.3 months (range - 8.3 to 22 months). Average lengthening achieved was 4 cm (0-9 cm). Treatment index was 2.1 month/cm. CONCLUSION: The monolateral rail fixator is simple, effective, easier to apply and more patient compliant with acceptable functional and radiological outcome.
INTRODUCTION: Management of the complex non union of tibia is a challenging task due to infection, bony gap, deformity, poor bone quality and poor soft tissue cover at fracture site. The limb reconstruction system (LRS) or Rail fixator has emerged as a viable option for the treatment of the same as it can address most of all above problems. It is more patient friendly and easier to apply in comparison to Ilizarov ring fixator. MATERIAL AND METHODS: Twenty two patients (17 males and 5 females) with complex non union of tibia underwent thorough debridement and resection of non viable bone followed by bone transport to fill the gap and then lengthening (8 patients) or acute docking & lengthening (14 patients) by the use of rail fixator. The average time to union, bone gap filled, lengthening achieved, treatment index were measured. The bone and functional outcome assessment was done by ASAMI score. The complications were classified according to Paley's classification. RESULTS: Union without residual infection was achieved in 20 (90.1%) patients while 2 patients had failure. As per ASAMI criteria bone results were excellent in 12 (54.5%), good in 5 (22.7%), fair in 3 (13.6%) and poor in 2 (9.1%). Functional results were excellent in 11 (50%), good in 5 (22.72%), fair in 4 (18.18%) and failure in 2 (9%). Mean treatment duration was 8.2 months (range 7-19 months). Mean follow up duration was 11.3 months (range - 8.3 to 22 months). Average lengthening achieved was 4 cm (0-9 cm). Treatment index was 2.1 month/cm. CONCLUSION: The monolateral rail fixator is simple, effective, easier to apply and more patient compliant with acceptable functional and radiological outcome.
Authors: Kevin Tetsworth; Dror Paley; Cengiz Sen; Matthew Jaffe; Dean C Maar; Vaida Glatt; Erik Hohmann; John E Herzenberg Journal: Injury Date: 2017-07-12 Impact factor: 2.586
Authors: Arvin C Gee; Rebecca S Sawai; Jerome Differding; Patrick Muller; Samantha Underwood; Martin A Schreiber Journal: Shock Date: 2008-03 Impact factor: 3.454
Authors: Mahmoud A Mahran; Mohamed A Elgebeily; Nabil A M Ghaly; Mootaz F Thakeb; Hany M Hefny Journal: Strategies Trauma Limb Reconstr Date: 2011-03-01