Functional Outcome of Infected Non Union in Fractures of Long Bones Treated by Distraction Osteogenesis using Limb Reconstruction System

Objective: To assess the functional outcome of the treatment of infected non union of long bone fractures by distraction osteogenesis using limb reconstruction system. Methods: From January 2014 and November 2019, 20 patients who underwent treatment for infected non union were reviewed. The average age of the patients were 40 years (26 to 60 years). Most common mode of injury has been road traffic accident. 2 patients had fall of heavy object over the leg. Out of this , 14 cases were infected non union after internal fixation, 6 persons had Open Grade III b Gustilo Anderson fractures initially treated with external fixator. Among this all open Grade III b fractures are treated with skin or flap cover. Antibiotic bone cement spacers were used for 14 cases. Bone grafting done for 8 patients at the docking site. We did acute docking for 3 cm of gap at the non union site followed by corticotomy and distraction at the other end in two of our cases. Results were evaluated based on Association for Study and Application of the Method of Ilizarov (ASAMI) scoring. Results: Mean follow-up was 12 months. All the cases got primary bone union, and infection was controlled. Bone results were 10 excellent, 6 good, 3 fair and 1 poor and functional results were 15 excellent, 3 good, 1 fair and 1 poor. The mean length of time in healing for all patients were 4.5 months. The mean length of regenerate bone were 3.5 cm. The most common complication was pin tract infection, and 1 cases refractured at the docking site. Conclusions: Limb reconstruction system can be used effectively in cases of infective non union of long bones using internal bone transport technique. Devitalized bone resection and secondary bone lengthening helps in attaining a functional limb. LRS external fixation technique is helpful in re-establishing the limbs, which would have been at high risk of amputation.