Management of Complex Nonunion of Long Bones by Distraction Osteogenesis Using Monorail Fixator

Abstract

Background: Treatment of complex nonunion is tough in the context of previous surgeries, recurrent infection, shortening, bone loss, associated bone deformities, and joint stiffness. Various treatments are available, including the Ilizarov ring fixator which is well established, but poor patient compliance and the bulky fixator push us to conduct another method of bone transport and distraction osteogenesis by monorail fixator. We conducted a study on 26 patients to know the outcome of monorail fixator in the treatment of complex nonunion in terms of rate of union, duration of treatment, and frequency of complications. Materials and Methods: The study comprised 26 patients, 22 of whom were male and 4 were female. Majority of cases landing up as complex nonunion were as a result of road traffic accidents. Two-thirds of the patients presenting to us had an infection in the form of discharging sinus or quiescent sinus, while one-third of the patients had aseptic nonunion. Majority of the patients had an external fixator or infected implant at the time of presentation. Corticotomy was done in almost all (96.2%) of the patients. Results: Out of 26 patients, treatment was completed in 25 patients, and one patient was lost to follow-up. The mean treatment duration was 11.31 months ranging from 5 months to 21 months. The mean follow-up duration was 12.8 months ranging from 7 months to 22 months. Results were assessed according to the ASAMI scoring system. Bone results were excellent in 19 (76%), good in 3 (12%), fair in 2 (8%), and failure in 1 (4%) cases. Functional results were excellent in 20 (80%), good in 2 (8%), and fair in 2 (8%). One case was declared a failure. Pin tract infection was the most common complication. Other complications encountered were pain during distraction, pin loosening, and joint stiffness. There was no significant angular deviation (>15°) in any case. Neurovascular complications, joint subluxation, or fracture of regenerate was not seen in any of the cases. Delayed maturation of the regenerate was dealt with by slowing or stopping the distraction for some days. Conclusion: It is concluded that the limb reconstruction system (LRS) (monorail fixator) is less bulky and relatively simple to apply, patient compliance is very good, operating time is considerably less, and no preoperative frame assembly is required. Good patient satisfaction, less pain during bone transport, less fluoroscopy exposure, and easy care management of concomitant soft-tissue injury are added advantages of LRS (monorail fixator).

Keywords

• complex nonunion
• distraction osteogenesis
• infection
• limb reconstruction system (monorail)