Clinicoradiological Comparison of Outcomes of LRS Fixator and Ilizarov in Infected Nonunion of Tibia Based on Bone Gap Quantification: An Original Research

Abstract

Introduction:

The surgery of the fracture of the long bones is inherent to certain complications, one being nonunion. As various modalities are proposed, we aim in our study to compare the clinical and radiographic outcomes after the treatment with the Limb Reconstruction System (LRS) fixator and Ilizarov for the infected tibia with nonunion considering the bone gap quantifications.

Materials and Methods:

We conducted an observational prospective study among 40 subjects with tibial nonunion. They were grouped equally to be treated by the LRS fixator and Ilizarov. Clinical and radiographic outcomes were compared using the “Chi-squared and independent Student's t-test,” deliberating P < 0.05 as significant.

Results:

We observed no significant difference for both the groups in the clinical union and functional and radiographic outcome for the various gaps of the nonunion. There was no significant difference for the groups when the time of healing was compared.

Conclusion:

Comparable results are seen for both the treatment modalities. However, IL fixator performed better clinically, while the LRS was easily accepted by the patients.

INTRODUCTION

The increased utilization of bikes and other personal vehicles has been implicated as one of the reasons for road traffic accidents (RTA). More than half of the fractures are reported due to RTA.[1,2,3] Of the many complications that have been seen, the nonunion predominates along with the infection. There are multiple studies that have been proposed to treat the various variants of the nonunion. However, the outcomes of these studies were debatable. In recent years, surgical techniques have evolved, and many types of fixation devices have been applied for the treatment of the nonunion tibia.[4,5,6] Among them, the Ilizarov fixator (IL) and “railroad fixators (LRS)” are relatively modern which have been recently described with relatively good outcomes.[1,2,3,4,5,6] Hence, we aim in our study to compare the clinical and radiographic outcomes after the treatment with the LRS fixator and Ilizarov for the infected tibia with nonunion considering the bone gap quantifications.

MATERIALS AND METHODS

We conducted an observational prospective study among 40 subjects with tibial nonunion. The ethics clearance and the patient consent were obtained for the study. We included male subjects between the ages of 20 and 50 years who had no other medical conditions that might alter the outcome of the results. The subjects were divided equally as group IL and group LRS. Bone gap quantification was done and compared in both groups. Both the techniques were followed as per the protocol. Once the operation was done as early as possible, the movement was encouraged and the follow-up was done for 6 months. The imaging of the operation site was done to establish the union of the bone, and also by clinical test performed the success of the fixators established. The clinical and the radiographic values after the treatment “as per ASAMI classification (1995)” were compared using the “Chi-squared and independent Student's t-test” deliberating P < 0.05 as significant.

RESULTS

We observed that there was no significant difference for both the groups when the clinical and the radiographic results postoperatively were compared. The clinical and the radiographic results in majority of both the groups were excellent. When the bone quantification was done, majority of the cases were with <6 mm of gap (group IL-15, LRS-14) t, and for the gap of >6 mm, the number of cases were group IL-15 and LRS-14. There was a significant difference in the radiographic results among the groups for the two bone gaps of <6 mm and >6 mm (P = 0.007) [Table 1].

Table 1.

Comparison of the groups for the radiographic and the clinical results as per the “ASAMI classification (1995)”

	Radiographic results			Clinical results
	Excellent	Good	Fair/poor	Excellent	Good	Fair/poor/failure
Group IL	15	4	1	16	3	1
Group LRS	13	4	3	12	4	4
P	0.23			0.35
≤6 cm bone gap Group IL-15	10	3	2	10	3	2
Group I LRS-14	8	3	3	7	4	3
P	0.25			0.44
>6 cm bone gap Group IL-5	2	3	0	3	1	1
Group LRS-6	1	4	1	3	2	1
P	0.089			0.96
Overall
≤6 cm bone gap-29	18	6	5	16	7	6
>6 cm bone gap-11	3	3	1	6	3	2
P	0.007			0.85
Total	21	9	6	28	7	5

IL: Ilizarov, LRS: Limb Reconstruction System

DISCUSSION

We aimed to compare the two types of the fixators for the tibial nonunion cases. In our study, we found no significant variation for the two types of the fixators. The results of the study are consistent with the findings of the studies of Bhardwaj et al.[2] and Rohilla et al.,[3] Over 70% of the subjects reported an excellent outcome in our study similar to other studies.[1,2,3,7] No failure cases or any severe infections were registered in our study, which is dissimilar to the previous studies.[2,3] There were no cases that required bone grafting in our study. The IL has been proposed as an inclusive technique in the treatment of nonunion chronic tibial cases.[1,5,6] Both the fixators can be employed successfully for the cases where <6 mm of the bone gap, while in the cases with >6 mm gap, the IL fixator cab is suggested. The patient acceptance and comfort were reported for the LRS.[1,2]

The limitations of our study were the small sample size and dissimilar number of cases for the two bone gaps.

CONCLUSION

The two types of the fixators performed similarly. The IL showed superior results than the LRS clinically, though not significant. Further studies are suggested with a larger sample size.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.