Treatment of infected non union tibia: A novel technique - lengthening using limb reconstruction system over intramedullary nail

Abstract

Background: To assess combination of an intramedullary interlocking (IMIL) nail with limb reconstruction system (LRS) in cases of infected nonunion tibia and to show influence of nail in predicting good outcome. Materials and Methods: From 2009 to 2011, records of 20 patients (17 men and three women) aged 18 to 65 years (mean, 38.4 years) with infected nonunion of the tibia treated with the LRS over IMIL Nail technique were prospectively reviewed. According to Jain et al., patients were classified into five cases of A1, five cases of type A2, seven cases of type B1, and three cases of type B2. All cases underwent LRS and IMIL. Mean amount of target lengthening was 54.65 mm. The mean follow-up was 14 months. Results: Mean amount of tibia lengthening was 51.70 mm. Leg length equalization was achieved in 19 cases (±5). According to modified scoring by Paley et al., 12 patients had excellent results, three patients had good, four patients had fair outcome, and one patient had poor outcome. Mean distraction index was 0.97. Mean maturation index was 2.43. Mean consolidation index was 3.47. Mean healing index was 1.40. One case had proximal locking screw failure. One case developed pre mature consolidation as distraction was started at delayed period due to non-compliance. Two cases developed decreased dorsi flexion of ankle. Two cases required flap surgeries for cover of bone. One case had pin breakage, which had to be exchanged. One case developed re-infection. Conclusion: The advantages of this technique include complete eradication of infective foci, reduced risk of deformity during lengthening, decrease risk of fractures post external fixator removal and reduction of time required for external fixator use thus decreasing healing index: Number of days of external fixation required per centimetre of lengthening.