Short Term Results of a New Comprehensive Protocol for the Management of Congenital Pseudarthrosis of the Tibia

Abstract

Background:Treatment of Congenital Psuedarthrosis of Tibia (CPT) often poses significant challenges due to difficulty in achieving union and subsequent complications like refractures, implant failures, etc. Our new comprehensive protocol is aimed at achieving crossunion between the tibia and fibula.Aims and objectives:The aim of the present study is to evaluate the short-term results of our new protocol and to compare the results with our previously used techniques.Materials and Methods:10 patients with mean age 2.35 years (1 to 6.5 years) who were treated by our new comprehensive protocol were included in Group A, and 11 patients with mean age 2 years (1 to 5.5 years) who primarily underwent intramedullary rodding with bone graft were included in Group B. The new comprehensive protocol consisted of pre-operative Zolendronate infusion, surgery consisting of intramedullary fixation of tibia supplemented with Ilizarov ring fixator and bone grafting aimed at achieving tibia-fibula cross-union. Retrospective evaluation of serial radiographs was performed and outcomes with respect to union and subsequent complications were analysed.Results:10/10 (100%) patients in Group A united, whereas union was achieved in only 8/11 (72%) patients in Group B. The index surgery was successful in achieving union in all 10 patients in Group A, whereas in Group B 2.25 (1 to 4) surgeries were needed to achieve union. The time to union was significantly shorter in Group A (4.68 months) as compared to Group B (30.88 months). The cross sectional area of union was significantly greater in Group A (3.82 cm2) as compared to Group B (1.18 cm2). One patient in Group A needed a subsequent corrective osteotomy for tibial valgus, and one patient underwent tibia lengthening; whereas in Group B, two patients needed corrective osteotomes for residual malaligments.Conclusion:Our study demonstrates that the new comprehensive protocol is extremely effective for achieving sound union in Congenital Pseudarthrosis of Tibia.

Surgical treatment options for congenital pseudarthrosis of tibia in children: cross-union versus other options: a systematic review

“…Broadly, all surgical options for managing CPT fractures follow the sequence of hamartoma excision, stable fixation with appropriate implant and addition of some form of bone growth stimulants [19]. There are many fixation options for CPT in children but majority of studies in literature have used IMR, Ilizarov fixator, combined IMR with Ilizarov fixator and VFG.…”

“…To overcome this problem, telescopic nails like Fassier-Duval nails were introduced [19,71]. However, an eventual failure of telescopic nails due to procurvatum and valgus deformity in the tibia, still remain a problem [11,13,19]. If the distal fragment is small, tibiotalar and subtalar joint trans-fixation is usually necessary to achieve stable fixation, thereby sacrificing ankle joint mobility [4].…”

Cross-Union Surgery for Congenital Pseudarthrosis of the Tibia

“…They also demonstrated 100% union with no refracture (8/8 with a 7.4-year follow-up). Two other recent reports of cross-union treatment for CPT using modifications of the Paley and Choi methods show similar results: Vaidya et al [ 56 ] reported 10/10 patients healed with no refracture (100%), and Liu et al [ 57 ] reported on 17/17 patients healed with no refracture (100%) at 4-year follow-up. In addition an as-of-yet unpublished study (personal communication) by Dr. Bo Ning from Fudan University, Shanghai, China, reports on 18 patients with CPT treated by Paley cross-union protocol using all internal fixation, with 18/18 achieving CPT union with 0% refracture during a mean follow-up of 4.3 years (range 1.5–6.3 years) [ 58 ].…”

Ilizarov bone transport combined with the Masquelet technique for bone defects of various etiologies (preliminary results)

“…However, regardless of the primary bone fusion rates, most of the authors state that the probability of long-term bone union retention remains unpredictable due to biological factors of the disease characterized by low osteogenic potential. Therefore, methods to enhance this potential have been identified such as wrapping, grafting, crossunion of the tibia and fibula, and application of several biological agents to promote osteogenesis[ 27 - 30 ]. Our technology might also be used.…”