Analysis of the Treatment of Infected Nonunion of Long Bones using Monolateral External Fixator: A Prospective study

Vijayanand Thambiah, M (2006) Analysis of the Treatment of Infected Nonunion of Long Bones using Monolateral External Fixator: A Prospective study. Masters thesis, Kilpauk Medical College, Chennai.


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INTRODUCTION: Ununited fractures of long bones are not only a complex surgical problem but also a chronic and at times debilitating condition. Infected nonunion of long bones are not only a source of functional disability but also can lead to economic hardship and loss of self-esteem. Infected nonunion13, 32 has been defined as a state of failure of union for 6 to 8 months with persistent infection at the fracture site. Infected nonunion can develop after an open fracture, after a previous open reduction and internal fixation (ORIF), or as sequelae to chronic hematogenous osteomyelitis. The incidence also seems to be increasing especially in view of increasing high velocity trauma, which is more frequently treated with internal fixation. It is difficult to treat infected nonunion because of the following reasons. Hence the treatment of Non-union of long bones associated with infection is a formidable challenge to the orthopaedic surgeon. Bone union is not usually obtained until the infection has been eradicated. The method known as the distraction osteogenesis simultaneously addresses deformity, shortening, loss of bone function, osteoporosis and soft tissue atrophy. AIM: The aim of the study is to analyze the outcome of treatment of infected Nonunion of long bones using Monolateral external fixator (The dynamic external fixation system and Rail fixation system), and to reveal its real usefulness. MATERIALS AND METHODS: This is a prospective study conducted at Govt. Royapettah hospital and K.M.C., which consists of 21 cases in the age range from 16 yrs to 65 yrs (with a mean age of 37.5 yrs.) who were treated at our institution from July 2003 to Feb 2006.Patients who were lost to follow up were not included in this study. Our institution approved our treatment protocols and all patients gave written informed consent. There were 18 males and 3 females in our study with male to female ratio of 6:1. The cost of the original orthofix is high. The price is beyond the reach of our patients. Various Indian versions of Orthofix have been introduced in the recent past, which is much cheaper than the original and is available at an affordable price for the patients. We did not come across gross deformity as most of the cases in our study have had previous surgeries and the problem was mainly infected nonunion with minimal deformity. The most common organism isolated from draining nonunion was staphylococcus, other than that pseudomonas, proteus, klebsiella were also isolated in different cases. Fortunately we did not come across MRSA (Methicillin resistant Staph. Aureus) infection. Based on the culture report specific antibiotics were chosen and given to patients. Antibiotics have always been considered as complementary to surgery. RESULTS: In the last 32 months we had the opportunity to treat 21 cases of infected non-union with monolateral external fixator. Of the 21 patients 11 (52%) patients developed infected nonunion following open fracture and 10 patients (48%) developed infected nonunion following previous implant surgeries for closed fractures. Our follow up of cases varied from 6 to 28 months (mean 16.8 months). Union time ranged from 4 to 9 months (mean 5.9 months). Sinus tract got cleared in all cases except 3 where the sinus tracts were multiple and there was no progression towards union in those cases. (Case no 18,19,15). There was no difficulty in this series as far as transportation of bone. There was considerable delay in the consolidation phase in all cases. Out of 21 cases 11 cases had pin tract infection (52.3%). For wound dehiscence in the post operative period, split skin graft cover was given in two cases. CONCLUSION: In this study we conducted, we could achieve a success rate of 86%, giving good encouraging results to most of our patients. Hence we conclude that the Indian version of the monolateral external fixation system is effective and convenient method for the treatment of infected nonunion of long bones. This can also be used to correct the limb length discrepancies simultaneously, which can arise during the course of the treatment. Patient with poor cooperation are not good candidates for this technique, which requires wearing the frame for a long time, with probably additional secondary surgical procedures.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Treatment of Infected Nonunion ; Long Bones ; Monolateral External Fixator ; Prospective study.
Subjects: MEDICAL > Orthopaedics
Depositing User: Subramani R
Date Deposited: 16 Sep 2017 17:34
Last Modified: 17 Sep 2017 13:59

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