Long-term follow-up on the use of vascularized fibular graft for the treatment of congenital pseudarthrosis of the tibia

Sakamoto, Akio; Yoshida, Tatsuya; Uchida, Yukiko; Kojima, Tadao; Kubota, Hideaki; Iwamoto, Yukihide

doi:10.1186/1749-799x-3-13

Cited by 51 publications

(47 citation statements)

References 17 publications

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“…The purpose of this study is to evaluate a new technique in the treatment of CPT adapted to atrophic types. Today, the best results to achieve bone union have been reported using vascularized fibular grafting [8,9] and Ilizarov intercalary bone transport [10,11]. The transfer of healthy vascularized bone in the first case and increasing blood flow by proximal corticotomy and diaphyseal transfer in the second creates a favorable vascular environment for union while compensating for bone defects.…”

Section: Discussionmentioning

confidence: 99%

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Induced membrane technique for the treatment of congenital pseudarthrosis of the tibia: Preliminary results of five cases

Pannier

Péjin

Dana

et al. 2013

Journal of Children's Orthopaedics

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Purpose The purpose of this study was to evaluate the two-stage surgical technique combining induced membrane, spongy autograft and intramedullary fixation for the treatment of congenital pseudarthrosis of the tibia (CPT). Methods Three boys and two girls were treated by this technique between 2003 and 2008. All patients had type IV CPT in Crawford's classification. Four of them had a limited dystrophic form, whereas one case presented an extensive tibia bone dystrophy. The average age of patients at the time of surgery was 23 months (range 10-30 months), with an average follow-up of 5.8 years (range 2.4-8.1 years). Results Satisfactory tibial bony union was achieved in all cases at the last follow-up. Bone healing was obtained in the four limited forms after an average term of 4 months. One patient suffered from a non-displaced fracture that healed by casting in a usual period of time. The patient with an extensive dystrophic bone had to undergo a secondary inter-tibiofibular bone graft to finally achieve bone union. Conclusions The preliminary results show that this technique is successful in CPT. It may be used even in young children and offers a good alternative to other treatments available, avoiding external fixation and the technical difficulties of microvascular surgery.

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Section: Discussionmentioning

confidence: 99%

“…This technique is also the source of residual angulation, occurring in more than half the cases, in particular valgus and recurvatum deformities, which do not resolve during growth. Valgus ankle deformities on the side of the harvested fibula in growing children may cause chronic pain to develop later on [9].…”

Section: Discussionmentioning

confidence: 99%

Induced membrane technique for the treatment of congenital pseudarthrosis of the tibia: Preliminary results of five cases

Pannier

Péjin

Dana

et al. 2013

Journal of Children's Orthopaedics

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“…In other circumstances, more substantial LLD (7-8 cm) after bone tumor resection may require a lengthening procedure over the FVFG [21,39]. CPT reconstruction with FVFG also provides delayed complications such as LLD or axial deformities [38]. Four cases of lengthening procedures performed after CPT reconstruction with FVFG have been reported [23,25].…”

Section: Discussionmentioning

confidence: 99%

“…In CPT, resection of the pseudarthrosis followed by reconstruction remains the gold standard for this condition [38]. Depending on the surgeon's preference and the location of the defect, different techniques have been described [3,11,13,25,32,33,41].…”

Section: Discussionmentioning

confidence: 99%

“…Since its description by Taylor et al [40] in 1975, free vascularized fibular grafting (FVFG) has become a standard salvage procedure for reconstructing a segmental bone defect after diaphyseal bone resection for either bone tumor [10,12,13,15,16] or congenital pseudarthrosis [33,38]. When tumor resection is performed in children, growth-plate sparing is not always possible owing to tumor involvement.…”

Section: Introductionmentioning

confidence: 99%

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Case Reports: Lengthening of a Vascularized Free Fibular Graft

Courvoisier

Sailhan

Mary

et al. 2009

Clinical Orthopaedics &Amp; Related Research

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Wide bone resection is sometimes necessary for bone tumors, and reconstruction is a major challenge. Vascularized fibular graft is one alternative but may result in progressive limb-length discrepancy (LLD) in children with substantial growth left. Progressive distraction lengthening with an external fixator is now a standard procedure to generally correct LLD. However, lengthening of free vascularized fibular grafts for lower limb reconstruction has not been reported frequently and then only in small series or case reports. We report our experience with three patients with lengthening after tibial reconstruction with a free vascularized fibular graft and review the literature.

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Biomimetic Materials for Bone Tissue Engineering – State of the Art and Future Trends

et al. 2011

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Bone tissue engineering is extremely promising for regenerating large bone defects in orthopedic or maxillofacial surgery. It consists of harvesting, culturing and differentiating human mesenchymal stem cells in combination with scaffolds. Different cell sources, such as bone marrow or adipose tissue, have been studied. Biomaterials resembling bone extracellular matrix have been used for scaffolding cells. However, these macroporous calcium phosphate ceramics or biodegradable polymers are two dimensional structures at the cellular level and have low osteogenesis properties in vivo. In this paper, several biomimetic approaches involving hydrogels or particles for 3‐dimensional (3D) cell cultures are reviewed. High numbers of cells for low amounts of material induced abundant extracellular matrix formation in vitro and relatively large amounts of bone tissue formation in vivo. In addition, the 3D culture of several cell populations should make it easier for bone tissue constructs to vascularize, thus lifting the limits of current clinical applications.

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Long-term follow-up on the use of vascularized fibular graft for the treatment of congenital pseudarthrosis of the tibia

Abstract: Background: Congenital pseudoarthrosis of the tibia (CPT) is one of the most difficult conditions to treat.

Cited by 51 publications

References 17 publications

Induced membrane technique for the treatment of congenital pseudarthrosis of the tibia: Preliminary results of five cases

Induced membrane technique for the treatment of congenital pseudarthrosis of the tibia: Preliminary results of five cases

Case Reports: Lengthening of a Vascularized Free Fibular Graft

Biomimetic Materials for Bone Tissue Engineering – State of the Art and Future Trends

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