Abstract
We reviewed 78 femoral and tibial non-unions treated between January 1992 and December 2003. Of these, we classified 41 as complex non-unions, because of infection (22), bone loss or prior failed surgery to produce union. These were treated with Ilizarov frames. 39 of the 41 nonunions healed successfully at a median time of 11 months.
Using the ASAMI scoring system, we had 17 excellent, 14 good, 4 fair and 6 poor bone results. The functional results were excellent in 14, good in 14, fair in 2 and poor in 2. All but 2 patients were extremely satisfied with the results. The average cost of treatment to the treating hospital was approximately £30,000 per patient. In comparison the cost for a patient with a below-knee amputation was £999 per year. This would amount to a cost of £36,000 per patient in their lifetime.
There is therefore not a great difference between the cost of limb salvage and amputation. The difference that exists favours limb salvage, if patient selection can accurately predict the salvage of a useful limb. Early referral to tertiary centres would reduce the morbidity and the prolonged time off work. The results justify the expense but the NHS needs to make financial provision for reconstruction of complex nonunions.
