Residual Deformities Following Successful Initial Bone Union in Congenital Pseudoarthrosis of the Tibia

Abstract

The pathology of congenital pseudoarthrosis of tibia is an enigma and the treatment is challenging. Despite achieving union of the pseudoarthrosis, these patients may have compromised function secondary to residual deformities. The purpose of this study is to analyze the prevalence of these deformities, the morbidity caused by them, and the methods to overcome the problems. Sixteen patients who had a successful union were retrospectively reviewed. Clinically, the following parameters were assessed: pain, joint stiffness, and limb length discrepancy (LLD). Anteroposterior and lateral lower extremity radiographs were performed to analyze (1) union of the tibia and fibula, (2) deformity of the tibia, (3) degree of ankle valgus, (4) degree of calcaneus of the os calcis, (5) LLD, and (4) refracture. The average follow-up was 16 years from the first and 8 years from the last surgical procedure. Residual deformities included valgus of tibia (average 11.4 degrees) and procurvatum (average 19.4 degrees) deformities of the tibia or valgus deformity of the ankle (average 21.3 degrees) and calcaneus of the os calcis (average 46 degrees). There were 9 refractures in 8 patients. Nine patients had an LLD (average 3.5 cm). The study demonstrates that careful follow-up of these patients is necessary and residual problems are to be treated as they occur.

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

“…Therefore, it should perhaps be noted that there was a tendency for previous unoperated cases to have ankle pain at long-term follow-up, even though there had been no pain of short-term follow-up. In a previous report, ankle pain after the surgical procedure for VFG is associated with multiple operations utilizing intramedullary nails, consistent with our results [14], and degenerative changes in the ankle because of the ankle valgus deformity and the intramedullary rod passing through the ankle joint is considered to be the cause of the ankle pain [14][15][16]. Refracture is not uncommon following consolidation of VFG [13,17,18].…”

Association of Ilizarov's technique and intramedullary rodding in the treatment of congenital pseudarthrosis of the tibia

“…In our patient series, initial LLD was fully corrected in one patient, partially corrected in two and remained unchanged in one. No pseudarthrosis was observed at the lengthening site, as described by Inan [15].…”

“…Persistent pseudarthrosis of the fibula is known to cause ankle valgus deformity and functional impairment [9,15]. This condition is due to a high position of the fibular distal epiphysis and because of an asymmetric growth of the distal tibial physis that grows more medially than laterally [2,10].…”

“…Unfortunately, when multiple procedures fail to achieve union, amputation may be the consequence [6]. Treatment goals of achieving and maintaining union with joint alignment and symmetrical limb length may be compromised by refracture, residual deformity, limb length discrepancy or valgus deformity of the ankle [14,15]. For the last three decades electromagnetic or low-intensity pulsed ultrasound stimulation of the non-union, vascularized bone grafts, intramedullary nails and Ilizarov's fixator have all been used with variable degrees of success [6].…”

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

“…CPT is challenging to treat and, historically, amputation rates of up to 50 % have been reported [8,9]. There is the prospect of multiple operations with persistent pseudarthrosis or transient union followed by subsequent fracture, which, together with lower limb deformity and leg length discrepancy, lead to poor limb function [10,11].…”