Congenital pseudarthrosis of the tibia: The results of an evolving protocol of management

Nicolaou, N.; Ghassemi, Amirreza; Hill, Ruaraidh

doi:10.1007/s11832-013-0499-2

Cited by 15 publications

(14 citation statements)

References 39 publications

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“…Union of congenital pseudarthrosis of the tibia was defined as evidence of bridging callus on four cortices across the transverse tibial cortical defects without visible fracture line on both the anteroposterior and lateral radiographs [ 16 ].…”

Section: Methodsmentioning

confidence: 99%

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

Zhu

Mei

et al. 2016

BMC Musculoskelet Disord

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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.

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Section: Methodsmentioning

confidence: 99%

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

Zhu

Mei

et al. 2016

BMC Musculoskelet Disord

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“…When the bridging callus appeared radiographically and limb length equalization was achieved, the frame was dynamized in order to assess the mechanical stability of the regenerated bone until clinical radiographic healing was achieved. The Ilizarov fixator was removed after an X-ray taken in two planes showed corticalization of four cortices ( 10 ). The leg was protected in a long-leg cast for 12 weeks, with the patient using only partial weight-bearing.…”

Section: Methodsmentioning

confidence: 99%

Combination of the Ilizarov Method and Intramedullary Fixation for the Treatment of Congenital Pseudarthrosis of the Tibia in Children: A Retrospective Observational Study

et al. 2022

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PurposeCongenital pseudoarthrosis of the tibia (CPT) is a rare disease in children, and its treatment remains a challenge for orthopedic surgeons. The purpose of this study was to evaluate treatment outcomes of patients with CPT treated by using the Ilizarov method combined with intramedullary fixation.MethodEighteen patients evaluated retrospectively from January 2009 to January 2020 were treated using the Ilizarov method combined with intramedullary fixation. Demographic data, clinical characteristics, and complications were all recorded and investigated during the period of follow-up. Ankle function was evaluated by the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores at the last follow-up.ResultThe average follow-up was 39.2 months (25–85 months) for all 18 patients. The mean age was 6.2 years (3.5–11.2 years). Fourteen (77.8%) patients had a primary bone union at the site of pseudarthrosis, while four obtained union after secondary surgical intervention. The mean duration of the Ilizarov method was 8.1 months (4.2–13.5 months). Eight (44.4%) patients had a pin-tract infection during treatment. Four (22.2%) patients had proximal tibial valgus with a mean angle of 12.1° (5–25°), while seven (38.9%) patients had ankle valgus deformities with a mean of 10.3° (5–20°). Eleven (61.1%) patients had an average 1.4 cm of limb length discrepancy (LLD) (0.6–3.1 cm) postoperatively. Five (27.8%) patients had refracture and recovered after a secondary surgery. At the last follow-up, the average postoperative AOFAS score was 72 (55–84).ConclusionThe Ilizarov method combined with intramedullary fixation is an effective method for the treatment of CPT, which can facilitate bony union and help to prevent refracture. Management of fibular pseudarthrosis is associated with functional outcomes. It is necessary to follow up until skeletal maturity and evaluate long-term clinical outcomes.

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“…Union obtained may be temporary with 50% incidence of refracture [8] . Secondary surgery for knee, ankle, foot, mal-alignment and LLD increases the frustration of surgeon and agony of patient to end up with amputation of limb [9] . Involved limb is already short, removal of pathological tissue and tapering ends of bone further increases the limb-length discrepancy [10] .…”

Section: Outcome Of Congenital Pseudoarthrosis Tibia Treated With Illmentioning

confidence: 99%

Outcome of Congenital Pseudoarthrosis Tibia Treated with Illizarov Fixator in Children

Khan

Javaid

Zafar

et al. 2020

International Journal of Orthopaedics

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Congenital pseudarthrosis of the tibia: The results of an evolving protocol of management

Cited by 15 publications

References 39 publications

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

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

Combination of the Ilizarov Method and Intramedullary Fixation for the Treatment of Congenital Pseudarthrosis of the Tibia in Children: A Retrospective Observational Study

Outcome of Congenital Pseudoarthrosis Tibia Treated with Illizarov Fixator in Children

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