PROSPECTIVE OBSERVATIONAL STUDY OF LIMB RECONSTRUCTION IN TREATMENT OF OPEN TIBIAL DIAPHYSEAL FRACTURES.

Background: There is still dispute over how to manage open tibial diaphyseal fractures with bone loss. External xators, nailing, ring xators, and grafting with or without plastic reconstruction are all alternatives for treatment. Each treatment has its own set of consequences, such as acute docking difculties, shortening, trouble with soft tissue management, chronic infection, greater morbidity, repeated surgeries, longer hospital stay, malunion, nonunion, and increased patient disappointment. We assessed the effectiveness of the limb reconstruction system (LRS) in treating open tibial diaphysis fractures with bone loss as a denitive way of care to accomplish union and limb lengthening at the same time. Materials And Methods: 44 open tibial diaphysis fractures with bone loss of at least 4 cm or more and a mean age of 35.3 years were treated with the LRS following debridement. To maintain limb length, distraction osteogenesis was performed at an average rate of 1 mm per day away from the fracture site. After approximating the fracture ends, the dynamized LRS was left for another 15-20 weeks before the patient was mobilized with weight bearing to accomplish union. The functional assessment was performed using the Association for the Study and Application of Illizarov Methods (ASAMI) standards. Results: The average followup was 12 months. The average bone loss was 4.9 cm (range: 3–8 cm). The average duration of bone transport was 16 weeks (range 9-32 weeks), while the average period for LRS in situ was 42 weeks (range 25-48 weeks). The mean implant index was 54.8 days per centimeter. The average union time was 46 weeks (range 42 to 48 weeks), with a mean union index of 71.7 days/cm. Bony results according to the ASAMI rating were excellent 78% (34/44), good 12% (6/44) and fair 5% (2/44) with union in all but two patients, who had poor results (5%) with three patients having a leg length disparity of more than 2.2 cm. Functional outcomes were excellent in 86% (37/44), good in 9% (3/44), and fair in 5% (3/44). Three occurrences of pin tract infection were observed, with all being supercial and healing with dressings and medicines. Conclusion: The limb reconstruction system is effective for treating open fractures of the tibia with bone loss, achieving union and lengthening simultaneously. Its advantages include early union and limb lengthening, a simple surgical technique, and minimal invasive procedures. Patient compliance, ease of wound treatment, reduced hospitalization, and lower risk of problems such as infection, deformity, or shortening.