~ 1018 ~ International Journal of Orthopaedics Sciences 2018; 4(2): 1018-1023 ISSN: 2395-1958 IJOS 2018; 4(2): 1018-1023 © 2018 IJOS www.orthopaper.com Received: 25-02-2018 Accepted: 26-03-2018 Dr. Ibad Sha I Assistant Professor, Department Department of Orthopaedics, Govt. Medical College, Thiruvananthapuram, Kerala, India Dr. EK Shanavas Department of Orthopaedics, Govt. Medical College, Thiruvananthapuram, Kerala, India CS Vikraman Prof. Department of Orthopaedics, Govt. Medical College, Thiruvananthapuram, Kerala, India Correspondence Dr. EK Shanavas Department of Orthopaedics, Govt. Medical College, Thiruvananthapuram, Kerala, India Clinical outcome of limb reconstruction system (LRS) in the treatment of infected long bone shaft nonunion Dr. Ibad Sha I, Dr. EK Shanavas and CS Vikraman DOI: https://doi.org/10.22271/ortho.2018.v4.i2o.145 Abstract Objective: To summarize the clinical and functional outcomes of infected non-union cases who have been treated with LRS. Methods: Between January 2015 and September 2016, we treated 20 cases of infected nonunion of long bone with the LRS. 17 were males and 3 females.8 cases presented with infected implants while 7 cases were on external fixators. Initially we managed with implant removal and radical debridement followed by fixation with the LRS. Corticotomy and lengthening was done in 7 cases. The average duration for removal of LRS was 6.5 months. Distraction at the corticotomy site was done at the rate of 1 mm/day till lengthening was achieved and in those subjects where no corticotomy was done, acute docking and compression was given. Results: Union occurred in 95% cases and eradication of infection in 90% cases. For 13 patients bone results were excellent, 5 patients good, 1 patient had fair result and 1 had poor result. Regarding functional results 8 had excellent score, 11 had good score and 1 had failure as the limb was amputated based on ASAMI scoring system. Conclusion: LRS is an excellent alternative to Ilizarov fixation in the management of infected nonunion of long bones. It can be used to achieve union as well as to correct shortening in these cases. It is less cumbersome to the patient and more surgeon and patient friendly. Keywords: Infected nonunion, limb reconstruction system, corticotomy, Ilizarov Introduction Injuries and fractures have become so common in the present day, main reason being population explosion, with increase in road traffic accidents, traffic congestion and urbanization, mechanization and agriculturization. Long bones femur, tibia and humerus being the most commonly fractured [1] , their fracture management contributes significantly to the cost of orthopedic care being provided worldwide. Treatment options for long bone fractures vary according to the type of fracture, age group, bone density, soft tissue status and associated complications. Conservative methods used are casting or bracing for stable closed fractures. Operative techniques used are fixation with plates and screws, intramedullary nailing and external fixation. The most important complication following an open fracture is delayed union/nonunion. They contribute to about 10-20% of fracture treatment complication. Today open fractures with infection are perhaps the most common causes of nonunion. 3 Infected non-union is associated with multiple problems like osteomyelitis, bone and soft tissue distortion and loss, sinuses, osteopenia, joint stiffness and multidrug-resistant and at times multibacterial infection. Various modalities of treatment for infected nonunion of long bones described are extensive debridement, microvascular soft tissue flaps, external fixation with bone graft, Ilizarov ring fixator, bone transport through external fixator over nail and limb reconstruction system (LRS) [2] Antibiotic-impregnated cement for control of infection is a common technique before union at the fracture site achieved. In external fixation, fracture fragments can be realigned, compressed or distracted, without the need of opening fracture site. External fixators have the unique capability to stabilize bone and soft tissues at a distance from the operative or injury focus. If correctly applied, they provide unobstructed access to the relevant skeletal and soft tissue structures for their initial