Strategies in Trauma and Limb Reconstruction

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VOLUME 12 , ISSUE 1 ( April, 2017 ) > List of Articles

Original Article

Treatment of infected non-unions with segmental defects with a rail fixation system

Srikanth Mudiganty, Arup Kumar Daolagupu, Arun Kumar Sipani, Satyendra Kumar Das, Arijit Dhar, Parag Jyoti Gogoi

Keywords : Non-union, Femur, Tibia, Corticotomy, Bone transport, Rail fixation

Citation Information : Mudiganty S, Daolagupu AK, Sipani AK, Das SK, Dhar A, Gogoi PJ. Treatment of infected non-unions with segmental defects with a rail fixation system. 2017; 12 (1):45-51.

DOI: 10.1007/s11751-017-0278-6

License: CC BY-NC-SA 4.0

Published Online: 30-04-2017

Copyright Statement:  Copyright © 2017; Jaypee Brothers Medical Publishers (P) Ltd.


We conducted this study to evaluate the use of rail fixation system in infected gap non-union of femur and tibia as an alternative to the established Ilizarov circular fixator technique. Prospective study. The study was done in the Department of Orthopaedic surgery in a medical school and level I trauma center to which the authors are/were affiliated. Between June 2010 and June 2015, 40 patients with infected gap non-union of femur and tibia were treated with the rail fixation system. Patients who were willing to undergo surgery and participate in the post-operative rehabilitation were included in the study. After radical debridement, the system was applied and corticotomy done. For closure of bone gap, acute docking and distraction was done in 18 cases and segmental bone transport in 22 cases. Early mobilization of patient was done along with aggressive physiotherapy. Bone and functional results were calculated according to ASAMI scoring system, and complications were classified according to Paley classification. The mean follow-up period was 22.56 months (range 8–44). Bone union with eradication of infection was achieved in all but 1 case (97.5%). Bone results were excellent in 57.5%, good 40%, fair 0% and poor in 2.5% cases, while functional result was excellent in 32.5%, good 65%, fair 0% and poor in 2.5% cases. The rail fixation system is an excellent alternative method to treat infected gap non-union of femur and tibia. It is simple, easy to use and patient-friendly.

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  1. Struijs PA, Poolman RW, Bhandari M (2007) Infected nonunion of the long bones. J Orthop Trauma 21:507-511
  2. Ueng SW, Wei FC, Shih CH (1999) Management of femoral diaphyseal infected nonunion with antibiotic beads local therapy, external skeletal fixation, and staged bone grafting. J Trauma 46:97-103
  3. Cabenela ME (1984) Open cancellous bone grafting of infected bone defects. Orthop Clin N Am 15:427
  4. Gordon L, Chin EJ (1988) Treatment of infected nonunion and segmental defect of tibia with staged microvascular muscle transplantation and bone grafting. J Bone Joint Surg Br 70A:377-386
  5. Marsh JL, Prokuski L, Biermann JS (1994) Chronic infected tibial nonunions with bone loss: conventional techniques versus bone transport. Clin Orthop Relat Res 301:139-146
  6. Saridis A, Panagiotopoulos E, Tyllianakis M et al (2006) The use of the Ilizarov method as a salvage procedure in infected nonunion of the distal femur with bone loss. J Bone Joint Surg Br 88B:232-237
  7. Grivas TB, Magnissalis EA (2011) The use of twin-ring Ilizarov external fixator constructs: application and biomechanical proof of principle with possible clinical indications. J Orthop Surg Res 6:41
  8. Moss DP, Tejwani NC (2007) Biomechanics of external fixation: a review of the literature. Bull NYU Hosp Joint Dis 65:294-299
  9. Fragomen AT, Rozbruch SR (2007) The mechanics of external fixation. HSS J 3:13-29
  10. Belhan O, Ekinci A, Karakurt L et al (2008) The treatment of femoral shaft fractures in adults with hybrid Ilizarov external fixator. Joint Dis Relat Surg 19:50-54
  11. Green SA, Harris NL, Wall DM et al (1992) The Rancho mounting technique for the Ilizarov method—a preliminary report. Clin Orthop Relat Res 280:104-116
  12. Mahran MA, Elgebeily MA, Ghaly NA et al (2011) Pelvic support osteotomy by Ilizarov's concept: is it a valuable option in managing neglected hip problems in adolescents and young adults? Strateg Trauma Limb Reconstr 6:13-20
  13. Charalambous CP, Akimau P, Wilkes RA (2009) Hybrid monolateral- ring fixator for bone transport in post-traumatic femoral segmental defect: a technical note. Arch Orthop Trauma Surg 129:225-226
  14. Inan M, Bomar JD, Kucukkaya M et al (2004) A comparison between the use of a monolateral external fixator and the Ilizarov technique for pelvic support osteotomies. Acta Orthop Traumatol Turc 38:252-260
  15. Rosen H (1998) Nonunion and malunion. In: Browner BD, Levine AM, Jupitar JB (eds) Skeletal trauma: fractures, dislocations, ligamentous injuries. WB Saunders, Philadelphia, pp 501-541
  16. Heckman JD, Ryaby JP, McCabe J et al (1994) Acceleration of tibial fracture healing by non-invasive, low intensity pulsed ultrasound. J Bone Joint Surg Am 76:26-34
  17. Paley D, Catagni MA, Argnani F et al (1989) Ilizarov treatment of tibial nonunions with bone loss. Clin Orthop Relat Res 241:146-165
  18. Paley D (1990) Problems, obstacles, and complications of limb lengthening by the Ilizarov technique. Clin Orthop Relat Res 250:81-104
  19. Ilizarov GA (1992) The tension-stress effect on the genesis and growth of tissues. In: Green SA (ed) Transosseous osteosynthesis: theoretical and clinical aspects of the regeneration and growth of tissue. Springer, Berlin, pp 137-256
  20. Slatis P, Paavolainen P (1985) External fixation of infected nonunion of the femur. Injury 16:599-604
  21. Barquet A, Silva R, Massaferro J et al (1988) The AO tubular external fixator in the treatment of open fractures and infected non-unions of the shaft of the femur. Injury 19:415-420
  22. Association for the Study and Application of the Method of Ilizarov Group (1991) Non-union of the femur. In: Bianchi- Maiocchi A, Aronson J (eds) Operative principles of Ilizarov. Fracture treatment, non-union, osteomyelitis, lengthening, deformity correction. Lippincott Williams and Wilkins, Baltimore
  23. Cattaneo R, Catagni M, Johnson EE (1992) The treatment of infected nonunions and segmented defects of the tibia by the methods of Ilizarov. Clin Orthop Relat Res 280:143-152
  24. Dendrinos GK, Kontos S, Lyritsis E (1995) Use of the Ilizarov technique for treatment of non-union of the tibia associated with infection. J Bone Joint Surg Am 77:835-846
  25. Barbarossa V, Matkovic BR, Vucic N et al (2001) Treatment of osteomyelitis and infected non-union of the femur by a modified Ilizarov technique: follow-up study. Croat Med J 42:634-641
  26. Eralp L, Kocaoglu M, Bilen FE et al (2010) A review of problems, obstacles and sequelae encountered during femoral lengthening: uniplanar versus circular external fixator. Acta Orthop Belg 76:628-635
  27. Plowden J, Renshaw-Hoelscher M, Engleman C et al (2004) Innate immunity in aging: impact on macrophage function. Aging Cell 3:161-167
  28. Gee AC, Sawai RS, Differding J et al (2008) The influence of sex hormone on coagulation and inflammation in the trauma patients. Shock 29:334-341
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