MANAGEMENT OF COMPLICATED TRAUMA BY LIMB RECONSTRUCTION SYSTEM (MONO-LATERAL EXTERNAL FIXATOR) IN LOWER EXTREMITY

Abstract

Introduction: High velocity trauma is the cause of maximum number of fatality in the younger age group worldwide. In the field of trauma surgery open fractures of the leg remain with the higher complication rate. Treatment options include wound debridement reduction and immobilization with cast, open reduction and plate fixation, external fixation, and IM nailing. Limb reconstruction system (LRS) is a unilateral rail system which consists of Schanz pins, rail rods, and sliding clamps. LRS was considered as definitive management for open fractures. LRS with its modular attachments, it is specifically designed to enable the surgeon to perform simple and effective surgery as it offers rigid fixation of fracture fragments, allows early weight bearing, and reduces the economic burden.

Aim: The aim of the study was to determine the efficacy of mono-lateral external fixator LRS for management of the lower extremity long bone fracture (tibia/femur).

Methods: A prospective study was carried out where 26 cases of lower extremity trauma (complicated) managed by LRS over a period of 5–6 months. The patients ranged from age 13 years to 67 years. Majority were male and predominant mode of injury was road side accidents. Majority of case were exposed to multiple the surgeries before LRS application. Most of the cases are of infection non-union. All the patients were treated at our hospital. These surgeries were done from June, 2005 to 2007. Any bone fragments that were protruding out we recovered with sterile dressing. The patient were taken to the operating room and treated by pulsed lavage and debridement the wound and splints. In patients, whose bone was exposed, as the wound condition improved the patients were planned for flap rotation. Assessment of quality of regenerate was done by plain radiography and clinical assessment at every follow-up. Final assessment for bone results and functional results was done using Association of the study and application of the method of Ilizarov (ASAMI) score.

Results: Among 26 patients, bony results as per ASAMI score were excellent in 73.07% (n=19), good in 19.23% (n=5), fair in 3.84% (n=1), and poor in 3.84% (n=1). Functional results were excellent in 84.7% (n=22), good in 11.5% (n=3), and fair in 3.8% (n=1). All the 26 cases of lower extremity fracture were kept on LRS external fixator for a period of 5–6 months on an average depending on the rate of union, after which the fixator was removed. For 2 patients nailing was done after LRS frame removal. Average time for frame removal was 28 weeks. In most cases union was complete by 7–8 months, the least being 5 months for a tibia shaft fracture. The average hospital stay for the patients was 7 days and as compared to multi staged surgery financial burden was reduced by 40%. The average time of return to work for the patients was 3 weeks.

Conclusion: Overall LRS proved to be an effective modality of treatment in cases of the lower extremity fracture with bone loss as definite modality of treatment for damage control as well as for achieving union and lengthening/transportation, deformity correction simultaneously, with the advantage of simple surgical technique, ease of application, minimal invasive, strong fixation, high patient compliance, early weight bearing, easy wound management, and the lower rate of complication.