Free vascularised fibular graft in the treatment of congenital pseudarthrosis of the tibia

Abstract

Five cases of congenital pseudarthrosis of the tibia successfully treated by a free vascularised fibular graft are described. Follow-up ranged from 5 to 34 months with a mean of 17.5 months. The technique, which includes radical excision of abnormal bone and soft tissue around the pseudarthrosis, also permits primary bone lengthening, and correction of deformity. The early results indicate that satisfactory bony union is achieved in a relatively short period of time.

Vascularised fibular graft for the treatment of congenital pseudarthrosis of the tibia: long-term complications in the donor leg

“…Many authors recommend arthrodesis or transfixation with a screw of the distal tibiofibular joint in patients with open physis, in order to avoid the valgus deformity of the ankle and proximal migration of the lateral malleolus [5,7,9,11,15,17,22]. Although we frequently observed proximal migration of the lateral malleolus, we could not associate this with clinical complications.…”

“…In the past, surgical solutions yielded negative results, and sometimes even culminated in amputation. Even with the evolution of treatment, many techniques are described, the most common being the Ilizarov external fixator through the distraction osteogenesis method with increased angiogenesis [2,3,10], intramedullary nailing with or without bone graft [4], and vascularised fibula graft have all been advocated for primary, or secondary surgery [3,7,17,19,21]. Advances in molecular biology have resulted in some recent studies that use recombinant human bone morphogenetic proteins for the treatment of CPT [12,16].…”

“…Vascularised fibular graft from the contralateral leg is already common practice, with good results reported [3,7,17,19,21]. Although many complications can occur in the graft donor leg, few reports specifically relating to the donor leg have been published.…”

Failed treatment of congenital pseudoarthrosis of the tibia—a case of llizarov-transportation of proximal tibia with arthrodesis to talus

“…Several treatments for congenital pseudoarthrosis of the tibia have been de- 1985), free vascularized fibular grafts (Hagan and Buncke 1982, Pho et al 1985, Weiland et al 1990), electrical stimulation (Bassett and Schink-Ascani 1991) and, recently, external fixation ( Paley et al 1992, Boero et al 1997, Ghanem et al 1997, Guidera et al 1997. Amputation remained a treatment option because success rates remained extremely low (Paterson 1989).…”

Progressive valgus deformity of the donor-site ankle after extraperiosteal harvesting the fibular shaft in children. Treatment with osteotomy and synostosis at one session

“…In some studies this option is mentioned as a side issue. 1,3 For sure if continuity is restored, it will prevent any deformity. Although this may be successful in smaller defects, 7,16 in the larger defects reconstruction is rather difficult with a high failure rate and morbidity, thus not acceptable as a preventive method 6 Correction of an established symptomatic valgus deformity may be achieved gradually with a temporary hemiepiphysiodesis or at once with a supramalleolar osteotomy.…”