Combination of intramedullary rod, wrapping bone grafting and Ilizarov’s fixator for the treatment of Crawford type IV congenital pseudarthrosis of the tibia: mid-term follow up of 56 cases

Abstract

BackgroundThe purpose of this study was to investigate the initial union rate, refracture rate and residual deformities of congenital pseudarthrosis of the tibia (CPT), using combined surgery including pseudarthrosis resection, intramedullary rodding, autogenous iliac bone grafting and Ilizarov’s fixator, with a mean 5.2 years follow-up.MethodsWe retrospectively reviewed the records and diagrams of patients with Crawford type IV congenital pseudarthrosis of the tibia between February 2007 and March 2010. Patients managed by pseudarthrosis resection, intramedullary rod of the tibia, wrapping autogenous iliac bone grafting and Ilizarov’s fixator were enrolled. We evaluated the bone union rate, tibial alignment, limb length discrepancy (LLD), valgus deformity of the ankle and the frequencies of refracture during period of follow-up.ResultsThere were 56 cases enrolled in the study, with a mean follow-up 5.2 years (range, 3 to 6.7 years). The mean age of the patients at surgery was 3.5 years (range, 1.5 to 12.4 years). Fifty (89.2 %) of the 56 patients had primary bone union at site of pseudarthrosis, while 5 obtained union after second surgery and 1 failed. The average time spent to obtain pseudarthrosis initial union was 4.5 months (range, 3.0 to 10.0 months) and mean duration of Ilizarov treatment was 4.7 months (range, 3.2 to 10.4 months). Eleven (19.6 %) patients had proximal tibial valgus with a mean angle of 9.5° (range, 5 to 24°), while 10 (17.9 %) patients had ankle valgus deformities with a mean of 12.3° (range, 6 to 21°). Sixteen (28.6 %) patients had an average 2.2 cm LLD (range, 1.5–4.2 cm). Of the 50 cases who obtained initial bone union of pseudarthrosis, 13 (26.0 %) had refracture which need cast immobilization or secondary surgery.ConclusionsThis combined surgery obtained initial union rate of 89.2 % at primary surgery while the refracture rate is 26.0 %. However, residual deformities such as proximal tibial valgus, LLD and ankle valgus were also existed which should be pay more attention to and dealt with.Trial registrationThis study was registered in ClinicalTrials.gov under the name “The Effect of Combined Surgery in Management of Congenital Pseudarthrosis of Tibia” (NCT02640040), which was released on August 31, 2015.

A case report of early unilateral external fixation by 3D printing and computer-assisted and secondary bone graft internal fixation in pseudarthrosis of the tibia surgery

“… 8 Usually, an intramedullary rod is used for CPT. 5 , 9 Despite the variety of surgical procedures for the treatment of CPT, 10 – 12 the choice of surgical approach centres on three basic premises: (i) union of the pseudarthrosis; (ii) prevention of fractures; and (iii) the correction of any limb deformities. This current case report describes an approach to the treatment of CPT that used unilateral external fixation based on the Ilizarov technique, 3D printing and computer-assisted orthopaedic surgery.…”

“… 4 These cases also tended to require proximal bone extension for bone shortening and osteotomy for distal pseudarthrosis resection with the Ilizarov technique. 5 However, the surgical treatment of such diseases remains a challenge for orthopaedic surgeons and a variety of surgical methods are often combined for CPT. 5 The advent of 3D printing and computer-assisted techniques in recent years has provided a new auxiliary technique for treatment planning and implementation.…”

“… 5 However, the surgical treatment of such diseases remains a challenge for orthopaedic surgeons and a variety of surgical methods are often combined for CPT. 5 The advent of 3D printing and computer-assisted techniques in recent years has provided a new auxiliary technique for treatment planning and implementation. 6 This current case report is a description of how the use of 3D printing and computer-assisted techniques can provide a 1:1 model of the tibia and fibula including any ankle joint deformity to precisely plan the surgical procedure.…”

Short Term Results of a New Comprehensive Protocol for the Management of Congenital Pseudarthrosis of the Tibia

“…The basis of successful surgical treatment relies on three principles: Excision of the hamatomatous periosteum, stable fixation, and bone grafting. The various options for grafting have been dual onlay bone grafts of Boyd and Sage,5 bypass graft by McFarland,24 cortical onlay grafting,25 vascularized bone graft,21 wrapping bone graft,26 and induced membrane technique 2728. Various options for fixation include internal fixation with plate and screws, internal fixation with IM nail (fixed or telescopic), and external fixation.…”

Combined surgery with 3-in-1 osteosynthesis in congenital pseudarthrosis of the tibia with intact fibula

“…Presently, the global primary union rate of congenital pseudarthrosis of the tibia (CPT) is relatively high [1][2][3][4][5][6]. However, preventing complications is challenging.…”