Management of congenital pseudarthrosis of the tibia with the Ilizarov method in a paediatric population: influence of aetiological factors

Borzunov, D.Yu.; Chevardin, A. Y.; Mitrofanov, Alexander I.

doi:10.1007/s00264-015-3029-7

Cited by 33 publications

(37 citation statements)

References 26 publications

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“…Лечение пациентов с врожденным ложным суставом костей голени остается актуальной проблемой современной ортопедии ввиду того, что в первую очередь сложно достичь консолидации в области псевдоартроза [1][2][3][4][5][6]. Однако при достижении желаемого результата в виде восстановления целостности большеберцовой кости начинается новый этап лечения [7].…”

Section: актуальностьunclassified

“…При укорочениях и деформациях длинных костей нижних конечностей метод Илизарова явля ется стандартом лечения [8,9]. Известно, что применение современных чрескостных аппаратов и узлов на базе компьютерной навигации позволяет достичь очень высокой точности коррекции деформации -от 80 до 96 %, по данным разных авторов [1][2][3][4][5][6]. Деформации костей голени у детей с кВЛСКГ не исключение [5].…”

Section: актуальностьunclassified

“…По окончании периода фиксации был выявлен рецидив деформаций берцовых костей с формированием вершины деформации на уровне проксимальной и дистальной зон роста большеберцовой кости (мМПрББУ -94°, мЛДББУ -82°, аЗПББУ -86°, аПДББУ -80°) (рис. [1][2][3][4] дез костей здоровой конечности с целью ее укорочения. Необходимо отметить, что в двух случаях из трех получены осложнения в виде ложного сустава.…”

Section: клинический примерunclassified

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Treatment of deformities in patients with healed congenital pseudarthrosis of the tibia

Zakharjan

Анатольевна²,

Pozdeev

et al. 2018

Pediatr Traum Orthop Reconstr Surg

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Background. Correction of deformities and lengthening of the lower extremities in patients with healed congenital pseudarthrosis of tibia (cCPT) is associated with certain characteristics, difficulties, and complications. But even the restoration of the anatomy and length of the tibia does not solve the problem of further recurrence of the deformity. Aim. This study aimed to evaluate the results of the correction of deformities of the tibia in patients with congenital pseudarthrosis of the tibia after achieving union by using external fixation and guided growth. Materials and methods. The results of treatment of 19 patients with cCPT, aged 4–15 years, which were observed in the Department of the Turner Scientific Research Institute from 2013 to 2018 years, were analyzed. We analyzed the types of deformities before the stage of correction deformities, evaluated the accuracy of the correction deformities after two-level osteotomies of the tibia, and used ortho-SUv passive computer navigation. External fixation index and number of complications were also determined. The type and number of recurrence of deformities and the timing of their detection were analyzed. Results. On the basis of clinical classification, patients with cCPT had complex deformities of the affected lower limb. The accuracy of the correction of deformities was 84% at the end of the correction period. The amount of elongation was 4.5 ± 1.5 cm. The IEF was 64.3 ± 40.6 days/cm. After the end of the external fixation period, deformities recurred in 100% of cases. In 17 patients, temporary hemiepiphysiodesis of the tibial bones, the second stage, was performed. The accuracy of the correction was 100%. The period of correction ranged from 12 to 14 months. Discussion. In the literature, we found no studies investigating the accuracy of the deformity correction, the choice of the level of osteotomies in patients with cCPT. Considering these data and the experience of the senior author of the publication, we performed two osteotomies of the tibia, outside the consolidation zone of the pseudarthrosis. High accuracy of the correction deformities was achieved in conjunction with the use of the ortho-SUv frame. Conclusion. The analysis showed that the deformity relapsed in 100% of children as the child grows, regardless of the accuracy of the deformity correction in children after achieving union CPT. Hemiepiphysiodesis is an effective treatment for this complication.

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Section: актуальностьunclassified

Section: клинический примерunclassified

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Treatment of deformities in patients with healed congenital pseudarthrosis of the tibia

Zakharjan

Анатольевна²,

Pozdeev

et al. 2018

Pediatr Traum Orthop Reconstr Surg

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“…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.…”

Section: Introductionmentioning

confidence: 99%

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

Liu

Yang

Liu

et al. 2020

Orphanet J Rare Dis

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Background: Re-fracture is the most serious complication in congenital pseudarthrosis of the tibia (CPT). There are reports that children with small cross-sectional areas in the sections of the pseudarthrosis are more prone to refracture. Presently, preventing complications is a challenge. Increasing the cross-sectional area in healed segments may reduce the incidence of re-fracture. Purpose: To elucidate the indications, surgical technique, and outcomes of combined surgery and 3-in-1 osteosynthesis in CPT with intact fibula. Methods: We retrospectively assessed 17 patients with Crawford Type IV CPT with intact fibula (Type A) who were treated with combined surgical technique and 3-in-1 osteosynthesis between March 2014 and August 2015. The average age of the patients at the time of surgery was 3 years. Incidence of re-fracture, ankle valgus, proximal tibial valgus, and limb length discrepancy (LLD) were investigated over an average follow-up time of 47 months. Results: Primary union was achieved in all patients. The average time for primary union was 4.9 months. Fifteen (88%) cases showed LLD with an average limb length of 1.6 cm; 6 (35%) cases exhibited tibial valgus with an average tibial valgus deformity of 7.8°; 2 cases had ankle valgus, wherein the ankle valgus deformity was 12°in one and 17°in another; and the cross-sectional area of the bone graft was enlarged to 1.74 times that of the tibia shaft. No case had re-fracture during the follow-up period. Movement of the ankle joint was restored in 16 patients with an average dorsiflexion of 22°and an average plantar flexion of 41°; the function of the ankle joint was normal. One patient had plantar flexion of 20°but did not have dorsiflexion. Conclusion: Combined surgical technique with 3-in-1 osteosynthesis, which is primarily considered for bone union with a large cross-sectional area, results in a high primary union rate. This can provide satisfactory results in shortterm follow-up when treating CPT with intact fibula (Type A).

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“…5,17,23 During this period complications can arise including pin site infection and fibrous union; patients and family members may experience physical inconvenience and psychosocial burden due to the retained external fixators, and there is a higher rate of fracture at the docking site. 14,24-26 These limitations hamper any large-scale clinical application of DO. The recommended rate of gradual bone lengthening as described by Ilizarov is 1 mm per day.…”

Section: Introductionmentioning

confidence: 99%

Stem cell therapy for enhancement of bone consolidation in distraction osteogenesis

Yang

Lin

Wang

et al. 2017

Bone & Joint Research

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ObjectivesDistraction osteogenesis (DO) mobilises bone regenerative potential and avoids the complications of other treatments such as bone graft. The major disadvantage of DO is the length of time required for bone consolidation. Mesenchymal stem cells (MSCs) have been used to promote bone formation with some good results.MethodsWe hereby review the published literature on the use of MSCs in promoting bone consolidation during DO.ResultsStudies differed in animal type (mice, rabbit, dog, sheep), bone type (femur, tibia, skull), DO protocols and cell transplantation methods.ConclusionThe majority of studies reported that the transplantation of MSCs enhanced bone consolidation or formation in DO. Many questions relating to animal model, DO protocol and cell transplantation regime remain to be further investigated. Clinical trials are needed to test and confirm these findings from animal studies.Cite this article: Y. Yang, S. Lin, B. Wang, W. Gu, G. Li. Stem cell therapy for enhancement of bone consolidation in distraction osteogenesis: A contemporary review of experimental studies. Bone Joint Res 2017;6:385–390. DOI: 10.1302/2046-3758.66.BJR-2017-0023.

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Management of congenital pseudarthrosis of the tibia with the Ilizarov method in a paediatric population: influence of aetiological factors

Cited by 33 publications

References 26 publications

Treatment of deformities in patients with healed congenital pseudarthrosis of the tibia

Treatment of deformities in patients with healed congenital pseudarthrosis of the tibia

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

Stem cell therapy for enhancement of bone consolidation in distraction osteogenesis

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