Clinical Outcome of Complex Non-unions Using the Linear Rail System

Abstract

Background: Complex non-union is considered to be one of the most challenging orthopedic situations to manage and the choice in such patients may be between limb salvage using limb reconstruction systems and amputation. Aim: To share our experience on the functional and radiological outcomes and complications of complex nonunion of femur and tibia treated with the linear rail system. Study Design: This is a 5-year retrospective study with prospective data collection. Place and Duration of Study: Department of clinical services, National Orthopaedic Hospital, Dala- Kano, Nigeria between January 2009 and December 2014. Results: A total of 92 patients were included of whom 72(78.3%) were males and 20(21.7%) were females. The mean age was 31.2±14.2 years and age range was 16-71years. There were 61(66.3%) tibial nonunion and 31(33.7%) femoral nonunion. The commonest complication encountered was pin tract infection in 40 (42.6%). The clinical outcome revealed that 52(57%) of patients had excellent bone result, 27(29.3%) had good bone result and 55(60.0%) had excellent functional result, 23(25.0%) had good functional result. Conclusion: This study revealed that majority of patients had satisfactory functional outcome with minimal complications following application of linear rail system. However, this is a long and arduous process requiring meticulous surgical technique, proper follow up, rehabilitation and patient compliance. Being a   specialized surgery requiring multidisciplinary care, its use should be confined to specialist centers for optimum outcome.