Comparison of Two Techniques of Reaming for Delayed-Union Long Bone Fractures of Lower Limb ? A New Innovative Technique

BACKGROUND- Delayed union and non-union are complications of fracture healing and remain problematic to treat. Approximately 5 % of all long bone fractures result in delayed union which most often progresses to non-union if not intervened. Delayed union is a potentially chronic condition associated with pain and functional and psychosocial disability. Delayed union is at substantial risk for becoming a non union without further intervention. There is no study available on treatment methods for delayed union of long bone fracture of lower limb including reaming in staged manner. MATERIALS AND METHODS- A randomized controlled study was conducted in the Department of Orthopaedics, ESI-PGIMSR model hospital, Basaidarapur New delhi. Total of 50 patients diagnosed to have delayed union of factures of long bones such as femur, tibia and fibula were included as cases and divided into two groups on the basis of randomization protocol decided prior to study. In group 1, technique 1 of reaming utilized which includes reaming of proximal fragment first with increasing size of reamer then reaming of distal fragment with increasing size of reamer. In group 2, technique 2 of reaming utilized which is classical technique of reaming both the fragments in sequential manner. Both the groups followed by nailing of adequate sizes and predetermined post-operative protocol. Statistical analysis was done using chi-square test and odds ratio. RESULTS- Both groups were compared for (1) duration from procedure and initiation of bridging callus, and (2) duration from procedure and complete union. Both groups were compared for the (3) number of patients required re-surgery for bone grafting in case of delayed union or non-union after procedure. Group 1 showed mean duration of 2 months from procedure and initiation of bridging callus and mean duration of 10 months from procedure and complete union. Only 5 patients in group 1 required re-surgery for bone grafting. While in group 2, mean duration from procedure and initiation of bridging callus found to be 3 months and mean duration from procedure and complete union found to be 12 months.13 patients in group 2 required re-surgery for bone grafting. There is clinically significant difference found between two groups in terms of re-surgery for bone grafting. DISCUSSION- Inadequate treatment of a fracture can result in delayed union. The ultimate goal of treating surgeon is to promote fracture healing and prevent complications like delayed union and non union. In our study we found better results with technique one of doing the reaming of proximal fragment first with increasing size of reamer then reaming of distal fragment with increasing size of reamer than technique two of reaming both the fragments in sequential manner in terms of speed of bone healing and recovery.