Evaluation of single stage protocol using Locked plate as primary fixation in treatment of infected non-union of long bones

Background: Infected non-union of long bones is one of the most challenging problems in clinical practice. In the treatment of infected non-union it is often difficult to achieve union and eradication of infection. The treatment strategy of infected non-union generally involves two stages: control of infection by local radical debridement of dead tissue and external fixator application followed by definitive treatment of bone stabilization and bone-grafting. Treatment with different methods of external fixators like Ilizarov, Orthofix had been gold standard in the past decade. However due to complications like prolonged fixation time, poor patient compliance, pin loosening and refracture after removal, there is need for alternative method of primary bone stabilization in infected non-union of long bones. The present study evaluates the results of single stage protocol of aggressive local radical debridement and internal fixation with locking compression plate as a primary means of stabilization in the treatment of infected non-union. Materials and Methods: Twenty one cases of infected non-union (5 femurs, 15 humerus, 1 tibia) were included in present study. The procedure included single stage protocol of exploration of the nonunion with aggressive local debridement, implant removal and reaming of intramedullary canal, antibiotic spacers and beads and Locking compression plate (LCP) as primary means of stabilization. Based on requirement and judgment by treating surgeon, revision debridement and removal of antibiotic bead with bone grafting was done as planned procedure. The evaluation of results included the union of the bone (both clinically and radiological), eradication of infection, complication rate, number of reintervention surgery. Result: The mean follow-up was 14 months (range 6 months to 5 years). We had achieved infection free union in 19 cases out of total 21cases. In 1 patient with previous infection had recurrence for which revision surgery with implant removal and refixation with L.C.P and bone grafting done? In another patient additional L.C.P plate with bone graft is applied. Infection free union is achieved in both cases. The functional outcome was satisfactory in most cases. The time to bone healing averaged 4.2 months (range 3 to 7 months) Conclusion: The proposed technique is effective in treating infected nonunion with resolution of infection and bone union. The inclusion of locking compression plate as internal splint improves stability of fixation, and along with proper and adequate local radical debridement, can be used as alternative method of fixation for obtaining fracture union with a good functional result.