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Outcome of rail fixator system in reconstructing bone gap.

Lakhani A, Singh D, Singh R - Indian J Orthop (2014)

Bottom Line: We had excellent to good limb function in 85% of cases as per the association for the study and application of the method of ilizarov scoring system[ASAMI] score.All patients well tolerated rail fixator with good functional results and gap reconstruction.Easy application of rail fixator and comfortable distraction procedure suggest rail fixator a good alternative for gap reconstruction of limbs.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedics, M. M. Medical College, Kumarhatti, Solan, Himachal Pradesh, India.

ABSTRACT

Background: Bone loss following open fracture or infected gap nonunion is a difficult situation to manage. There are many modes of treatment such as bone grafting, vascularized bone grafting and bone transport by illizarov and monolateral fixator. We evaluated the outcome of rail fixator treatment in reconstructing bone and limb function. We felt that due to problems such as heavy apparatus, persistent pain, deformity of joints and discomfort caused by an Ilizarov ring fixator, rail fixator is a good alternative to treat bone gaps.

Materials and methods: 20 patients (17 males and 3 females with mean age 30.5 years) who suffered bone loss due to open fracture and chronic osteomyelitis leading to infected gap nonunion. Ten patients suffered an open fracture (Gustilo type II and type III) and 10 patients suffered bone gap following excision of necrotic bone after infected nonunion. There were 19 cases of tibia and one case of humerus. All patients were treated with debridement and stabilization of fracture with a rail fixator. Further treatment involved reconstructing bone defect by corticotomy at an appropriate level and distraction by rail fixator.

Result: We achieved union in all cases. The average bone gap reconstructed was 7.72 cm (range 3.5-15.5 cm) in 9 months (range 6-14 months). Normal range of motion in nearby joint was achieved in 80% cases. We had excellent to good limb function in 85% of cases as per the association for the study and application of the method of ilizarov scoring system[ASAMI] score.

Conclusion: All patients well tolerated rail fixator with good functional results and gap reconstruction. Easy application of rail fixator and comfortable distraction procedure suggest rail fixator a good alternative for gap reconstruction of limbs.

No MeSH data available.


Related in: MedlinePlus

X-ray right arm with shoulder joint anteroposterior view showing (a) preoperative gap nonunion (b) immediate postoperative after removing dead piece of bone with final gap created
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Figure 1: X-ray right arm with shoulder joint anteroposterior view showing (a) preoperative gap nonunion (b) immediate postoperative after removing dead piece of bone with final gap created

Mentions: For 20 cases (17 male and 3 females with mean age of 30.5 years (range 16-45 years) of infected gap nonunion of long bones with bone loss due to open fracture and chronic osteomyelitis were included in study [Table 1]. In 19 cases, rail fixator was applied on tibia. There was only a single case of 1 month old open fracture humerus with accompanying brachial plexus injury of the same side, which was referred to our center with redness and raised local temperature. On debridement necrosed piece of bone removed and rail fixator applied [Figure 1A and B]. The gap nonunion was due to bone loss in open fractures (n = 10) and infected nonunion (n = 10) [Figure 2A and B]. Six cases had active sinuses with raised C-reactive protein. All patients in present study had previous operative procedures performed on them. Twelve patients had an average of two procedures and remaining 8 had three procedures. The average bone gap in this series was 7.72 cm (range 3-15 cm). This bone gap was either created at the time of injury or after thorough debridement following compound fracture or sequestrectomy. This study plan was approved by our institutional review board. Informed written consent was taken from all patients. The preoperative medical evaluation of all patients was done. The culture and sensitivity of discharge was sent preoperatively. The neurovascular status of limb was assessed preoperatively. All patients were treated with debridement and application of rail fixator in the same sitting. According to site of defect, appropriate corticotomy was done after settlement of wound to decrease the chance of infection at corticotomy site and it was done at second stage in all cases. Corticotomy was done at single level. Joint motion was started as early as possible after the operation Transport was commenced after 5-7 days of corticotomy. Rate of transport was 1.00 mm/day in 4 divided increments. At the conclusion of transport, the defect was closed by removing soft-tissue at docking site and giving compression between the bone ends in all cases. Partial weight bearing was strated at conclusion of transport. Consolidation of docking site was monitored by serial anteroposterior and lateral X-rays. Bone grafting was done in five cases when it was found callus formation was not adequate at docking site. Full weight bearing was advised when three distinct and complete cortices of regenerate were evident on serial X-ray.


Outcome of rail fixator system in reconstructing bone gap.

Lakhani A, Singh D, Singh R - Indian J Orthop (2014)

X-ray right arm with shoulder joint anteroposterior view showing (a) preoperative gap nonunion (b) immediate postoperative after removing dead piece of bone with final gap created
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4232832&req=5

Figure 1: X-ray right arm with shoulder joint anteroposterior view showing (a) preoperative gap nonunion (b) immediate postoperative after removing dead piece of bone with final gap created
Mentions: For 20 cases (17 male and 3 females with mean age of 30.5 years (range 16-45 years) of infected gap nonunion of long bones with bone loss due to open fracture and chronic osteomyelitis were included in study [Table 1]. In 19 cases, rail fixator was applied on tibia. There was only a single case of 1 month old open fracture humerus with accompanying brachial plexus injury of the same side, which was referred to our center with redness and raised local temperature. On debridement necrosed piece of bone removed and rail fixator applied [Figure 1A and B]. The gap nonunion was due to bone loss in open fractures (n = 10) and infected nonunion (n = 10) [Figure 2A and B]. Six cases had active sinuses with raised C-reactive protein. All patients in present study had previous operative procedures performed on them. Twelve patients had an average of two procedures and remaining 8 had three procedures. The average bone gap in this series was 7.72 cm (range 3-15 cm). This bone gap was either created at the time of injury or after thorough debridement following compound fracture or sequestrectomy. This study plan was approved by our institutional review board. Informed written consent was taken from all patients. The preoperative medical evaluation of all patients was done. The culture and sensitivity of discharge was sent preoperatively. The neurovascular status of limb was assessed preoperatively. All patients were treated with debridement and application of rail fixator in the same sitting. According to site of defect, appropriate corticotomy was done after settlement of wound to decrease the chance of infection at corticotomy site and it was done at second stage in all cases. Corticotomy was done at single level. Joint motion was started as early as possible after the operation Transport was commenced after 5-7 days of corticotomy. Rate of transport was 1.00 mm/day in 4 divided increments. At the conclusion of transport, the defect was closed by removing soft-tissue at docking site and giving compression between the bone ends in all cases. Partial weight bearing was strated at conclusion of transport. Consolidation of docking site was monitored by serial anteroposterior and lateral X-rays. Bone grafting was done in five cases when it was found callus formation was not adequate at docking site. Full weight bearing was advised when three distinct and complete cortices of regenerate were evident on serial X-ray.

Bottom Line: We had excellent to good limb function in 85% of cases as per the association for the study and application of the method of ilizarov scoring system[ASAMI] score.All patients well tolerated rail fixator with good functional results and gap reconstruction.Easy application of rail fixator and comfortable distraction procedure suggest rail fixator a good alternative for gap reconstruction of limbs.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedics, M. M. Medical College, Kumarhatti, Solan, Himachal Pradesh, India.

ABSTRACT

Background: Bone loss following open fracture or infected gap nonunion is a difficult situation to manage. There are many modes of treatment such as bone grafting, vascularized bone grafting and bone transport by illizarov and monolateral fixator. We evaluated the outcome of rail fixator treatment in reconstructing bone and limb function. We felt that due to problems such as heavy apparatus, persistent pain, deformity of joints and discomfort caused by an Ilizarov ring fixator, rail fixator is a good alternative to treat bone gaps.

Materials and methods: 20 patients (17 males and 3 females with mean age 30.5 years) who suffered bone loss due to open fracture and chronic osteomyelitis leading to infected gap nonunion. Ten patients suffered an open fracture (Gustilo type II and type III) and 10 patients suffered bone gap following excision of necrotic bone after infected nonunion. There were 19 cases of tibia and one case of humerus. All patients were treated with debridement and stabilization of fracture with a rail fixator. Further treatment involved reconstructing bone defect by corticotomy at an appropriate level and distraction by rail fixator.

Result: We achieved union in all cases. The average bone gap reconstructed was 7.72 cm (range 3.5-15.5 cm) in 9 months (range 6-14 months). Normal range of motion in nearby joint was achieved in 80% cases. We had excellent to good limb function in 85% of cases as per the association for the study and application of the method of ilizarov scoring system[ASAMI] score.

Conclusion: All patients well tolerated rail fixator with good functional results and gap reconstruction. Easy application of rail fixator and comfortable distraction procedure suggest rail fixator a good alternative for gap reconstruction of limbs.

No MeSH data available.


Related in: MedlinePlus