Bone Gap Management Using Linear Rail System (LRS): Initial Observations in a National Orthopaedic Hospital

Abstract

Background: Vascularized fibular grafting, free fibular graft, tibia profibula synostosis, amputation with a good prosthesis and Ilizarov technique are some of the suitable options for managing bone gaps that result from trauma or treatment of tumours, bone infection, congenital pseudoarthrosis and repeated failed osteosynthesis with shortening. We opted for the use of linear rail system (LRS) in the treatment of such cases.
Objective: To study the effectiveness of the linear rail system (LRS) in the management of bone gaps.
Method: Via lateral approach to the femur through previous surgical scars, the broken plate and screws as well as the broken intermediary nails were removed for case 1 and 3 respectively. Fibrolysis was effected and the bone ends trimmed. The gaps required on table to be bridged to achieve limb equality was 10 and 9cm respectively. The linear rail system device was applied, corticotomy performed in the supracondylar region of the femur and distraction commenced after a latency of 10 days. Case 2 had
debridement of his gunshot wound with a defect of 10cm created on table. LRS was applied and corticotomy effected. Distraction was commenced after latency of 7 days.
Results: Case 3 has completed his treatment, his device is removed after consolidation of 7cm of his regenerate. Case 1 and 2 have completed their distraction phase and are awaiting consolidation of 10cm regenerate each.
Conclusion: The linear rail system (LRS) appears to be an effective tool in the management of bone gap using the Ilizarov principle of distraction osteogenesis. It is simpler, more cosmetically acceptable to patients and less technically challenging and gives same result as the Ilizarov circular frame.

Key words: Bone gap, linear rail system, distraction osteogenesis.