Dr. K G Sathyendra, Department of Orthopaedics, ESI-PGIMSR, Hospital Basaidarapur, New Delhi-110015, India. E-mail: drsathyendrakg@gmail.com
Background: We intend to determine the utility of the limb reconstruction external fixator as a definitive tool in managing grade II and grade III compound long bone fractures.
Materials and Methods: All patients with Grade II and Grade III complex long bone fractures were evaluated clinically and radiologically before inclusion in this prospective observational cohort study. A minimum of 20 cases were studied after clearance from the Ethics Committee.
Results: In our study, there is a variable wound healing time, with 20% of patients getting their wound healed within 4 weeks and 80% of patients getting their wound healed within 12 weeks. The mean wound healing time was 9.45 ± 5.78 weeks. 18 patients (90%) in the study showed signs of radiological union with a radiographic union scale in tibial fracture score of 2 or 3. Mean bone union time was 18.11 ± 5.24 weeks after injury. According to the Association for the Study and Application of the Methods of Ilizarov (ASAMI) scoring system, the bone results were excellent in 14 (70%) patients, good in 3 (15%) patients, fair in 1 (5%) patient, and poor in 2 (10%) patients. The functional results as per the ASAMI scoring system were excellent in 13 (65%) patients, good in 6 (30%) patients, and poor in 1 (5%) patient. In our study, 11 patients did not encounter any complications. The common complication was pin tract infections. Limb shortening was observed in 45% of patients. 85% of patients had insignificant limb shortening and did not require a shoe raise.
Conclusion: In our study, we achieved excellent to good results in our series by using the limb reconstruction system type of external fixator with fracture union in all the patients in our study. Limb reconstruction external fixators can be used as definitive tools in managing grade II and grade III compound long bone fractures.
Keywords: Limb reconstruction external fixator, grade II and grade III compound long bone fractures, wound healing time, association for the study and application of the methods of ilizarov scoring system, complication.
References
- 1. Kim PH, Leopold SS. In brief: Gustilo-Anderson classification. Clin Orthop Relat Res 2012;470:3270-4. [Google Scholar]
- 2. Jindal R, Dhillon M, Mittal N, Aggarwal A, Malhotra A, Garg SK. Gaps in the care of open fractures: An Indian scenario. Indian J Orthop 2021;56:280-8. [Google Scholar]
- 3. Court-Brown CM, Rimmer S, Prakash U, McQueen MM. The epidemiology of open long bone fractures. Injury 1998;29:529-34. [Google Scholar]
- 4. Hoit G, Bonyun M, Nauth A. Hardware considerations in infection and nonunion management: When and how to revise the fixation. OTA Int 2020;3:e055. [Google Scholar]
- 5. Costa FC, Reis JM, Reis SP, Bartelega LA, Melo NF, Araújo CD. Epidemiology of open fractures and degree of satisfaction of initial care. Acta Ortop Bras 2022;30:e245221. [Google Scholar]
- 6. Elseth A, Nunez Lopez O. Wound grafts. In: StatPearls. Treasure Island, FL: StatPearls Publishing; 2024. Available from: https://www.ncbi.nlm.nih.gov/books/NBK564382 [Last accessed on 2025 Jul 05]. [Google Scholar]
- 7. Gessmann J, Citak M, Jettkant B, Schildhauer TA, Seybold D. The influence of a weight-bearing platform on the mechanical behavior of two Ilizarov ring fixators: Tensioned wires vs. half-pins. J Orthop Surg Res 2011;6:61. [Google Scholar]
- 8. Cross WW 3rd, Swiontkowski MF. Treatment principles in the management of open fractures. Indian J Orthop 2008;42:377-86. [Google Scholar]
- 9. Dheenadhayalan J, Nagashree V, Devendra A, Velmurugesan PS, Rajasekaran S. Management of open fractures: A narrative review. J Clin Orthop Trauma 2023;44:102246. [Google Scholar]
- 10. Cho SK, Mattke S, Gordon H, Sheridan M, Ennis W. Development of a model to predict healing of chronic wounds within 12 weeks. Adv Wound Care (New Rochelle) 2020;9:516-24. [Google Scholar]
- 11. Patil MY, Gupta SM, Kurupati SK, Agarwal S, Chandarana V. Definitive management of open tibia fractures using limb reconstruction system. J Clin Diagn Res 2016;10:RC01-4. [Google Scholar]
- 12. Gokul Nath R, Shabi AV. Orthofix in management of compound tibia fractures: A prospective study. MedPulse Int J Orthop 2017;3:8-12. [Google Scholar]
- 13. Ajmera A, Verma A, Agrawal M, Jain S, Mukherjee A. Outcome of limb reconstruction system in open tibial diaphyseal fractures. Indian J Orthop 2015;49:429-35. [Google Scholar]
- 14. Mahajan NP, Mangukiya HJ. Extended use of limb reconstruction system in management of compound tibia diaphyseal fracture as primary and definitive tool. Int J Res Orthop 2017;3:1157-64. [Google Scholar]
- 15. Pal CP, Kumar H, Kumar D, Dinkar KS, Mittal V, Singh NK. Comparative study of the results of compound tibial shaft fractures treated by Ilizarov ring fixators and limb reconstruction system fixators. Chin J Traumatol 2015;18:347-51. [Google Scholar]
- 16. Tekin AÇ, Saygılı MS, Adaş M, Çabuk H, Arslan SM, Dedeoğlu SS. Outcome of type 3 open tibial diaphyseal fractures managed with a limb reconstruction system: Analysis of a 49-patient cohort. Med Princ Pract 2016;25:270-5. [Google Scholar]
- 17. Aslan A, Uysal E, Özmeriç A. A staged surgical treatment outcome of type 3 open tibial fractures. ISRN Orthop 2014;2014:721041. [Google Scholar]
- 18. Gill SP, Raj M, Kumar S, Singh P, Kumar D, Singh J, et al. Early conversion of external fixation to interlocked nailing in open fractures of both bone leg assisted with vacuum closure (VAC)-Final outcome. J Clin Diagn Res 2016;10:RC10-4. [Google Scholar]