Efficacy external fixator in the management of infected nonunion fractures

Abstract

Management of infected nonunion of fractures is a difficult task for orthopedic surgeons in a manner to create bony stability, in recovery of soft tissue and fracture union. Several surgical treatment modalities have been available like bone grafting, antibiotic treatment, ilizarov methods and free soft tissue transfer. This study was conducted to assess the role of monolateral external fixators in infected nonunion of fractures. A total 40 infected nonunion cases were recruited based on AO classification. Patients with wounds of minimum 3 months were considered as non-draining cases. Blood investigations, microbiological investigation and radiological investigation were done. Special attention was focused on limb length measurements, range of motion of the joints, neuromuscular status and distal vascularity. The final surgical outcome was assessed asper ASAMI'S criteria with grade system. Among the cases, 65% nonunion fractures were observed in femur, 22.5% in tibia and 12.5% in humerus. Superficial pin tract infections was noticed in 48% cases and are responded to oral antibiotics. The final surgical outcome indicates that 90% cases had grade-I & II (excellent and good) recovery from infected nonunion fractures in bony and functional recovery. The monolateral external fixation system is effective and convenient method for the treatment of infected nonunion of long bones and is most reliable to rectify the limb length discrepancies.

Complications of Ilizarov method treatment for infected nonunion femoral shaft fracture

“…In most of the studies regarding femoral fractures, the mean age was between 25 to 44 years and males were predominant. [12][13][14] In this study, motor vehicle accidents accounted for 36 (90%) cases which was the most common cause of injury. Fall from height was accounted for 4 (10%) cases.…”

Outcome of Infected Nonunion of Long Bones Treated by Single-Stage Bone Grafting and External Fixation at Northwest General Hospital, Peshawar, Pakistan

“…5,6 Multiple surgical methods are being used for treatment of infected nonunions worldwide such as bone grafting, 5 tissue transfer, 6 antibiotic loaded cement, 1 external fixation and Ilizarov. 7 Bone grafting is a common technique but is associated with certain limitations/complications while treating larger bone defects, prolonged graft incorporation time and donor site morbidity. 8 Free tissue transfer is another feasible option for large bone defects and soft tissue loss but it is technically demanding and is associated with stress fractures and nonunion.…”