What Factors Influence Union and Refracture of Congenital Pseudarthrosis of the Tibia? A Multicenter Long-term Study

Shah, Hitesh; Joseph, Benjamin; Nair, Binu Valsalakumari Sreekumaran; Kotian, Devaki B.; Choi, In Ho; Richards, B. Stephens; Johnston, Charles E.; Madhuri, Vrisha; Dobbs, Matthew B.; Dahl, Mark T.

doi:10.1097/bpo.0000000000001172

Cited by 28 publications

(27 citation statements)

References 25 publications

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“…Recently there have been two multicentre or meta-analysis studies looking at large cohorts of patients with long follow-up in an effort to better understand the factors that increase success of achieving union and the actual refracture rate following union. 51,52 Shah et al 51 performed a long-term follow-up retrospective multicentre study to identify the factors that affect union and refracture of CPT. Patients were treated with a variety of methods including Williams rods, Ilizarov fixation, bone grafting and free vascularized fibula.…”

Section: Treatment Methods and Resultsmentioning

confidence: 99%

Congenital pseudarthrosis of the tibia: Biological and biomechanical considerations to achieve union and prevent refracture

Paley¹

2019

Journal of Children's Orthopaedics

144

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Congenital pseudarthrosis of the tibia (CPT) is likely to be a primary periosteal disease and secondary bone disease. The primary goal of treatment is to obtain union, correct the diaphyseal deformity, correct any proximal fibular migration and prevent refracture. The pathobiology demonstrates increased osteoclasis by the surrounding fibrous hamartoma and reduced osteogenesis and bone morphogenic protein production by the bone. This leads to a loss of remodelling potential and gradual bowing and atrophy of the bone with eventual fracture of the tibia and or fibula. This recommends the synergistic use of bisphosphonates and bone morphogenic protein. The pathomechanics of CPT implicate the anterolateral bowing, narrow diameter of the atrophic bone ends and proximal fibular migration. These biomechanical factors can be addressed by means of straightening of the deformity, intramedullary support of both bones, stable fixation and reduction of proximal migration of the fibula. A summary of the literature on CPT shows that the mean probability of achieving primary union without refracture, by most treatments is 50% (12% to 80%). Two recent studies have shown a much higher success rate approaching 100%, by creating a cross-union between the tibia and fibula. The cross-union with intramedullary reinforcement of the bone makes refracture unlikely due to the cross-sectional area of union with its two-bar linkage. A new classification to guide such treatment is also proposed. Level of Evidence V – expert opinion

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Section: Treatment Methods and Resultsmentioning

confidence: 99%

Congenital pseudarthrosis of the tibia: Biological and biomechanical considerations to achieve union and prevent refracture

Paley¹

2019

Journal of Children's Orthopaedics

144

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“…45 Unfortunately, results of multiple studies regarding the use of BMP remain inconclusive. 46,47 We are further exploring the possibility of incorporating BMP and MSC treatment.…”

Section: Discussionmentioning

confidence: 99%

Incomplete Eradication of Persistent Infection May Impede Union: Our Experience in Treating Fracture Non-Unions with Allogenic MSC

Dilogo¹,

Hanitya

Pawitan³

et al. 2020

Preprint

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Introduction : Non-union remains a major clinical challenge for orthopaedic surgeons, as the treatments are associated with risks for complications, and sometimes multiple surgeries are required. Mesenchymal stem cells (MSCs) have been found to aid in osteogenesis and fracture healing; however, the number of studies on MSC application for treating non-unions is still sparse. We present a translational study of 8 subjects treated with MSC implantation, along with those considered as standard treatments in treating non-unions. To our knowledge, this is the most extensive clinical study on the use of MSCs to treat fracture non-unions. Methods: We performed 20x10 6 units of MSC implantations derived from adipose tissue, bone marrow, and umbilical cord on subjects diagnosed with fracture non-union of the long bone, along with internal fixation and hydroxyapatite-calcium sulphate (HA-CaSO 4 ) pellets. We excluded pathological fractures, subjects with immunological deficiencies (type II diabetes mellitus, and HIV/AIDS), and subjects with a history of immunosuppressive therapies. All subjects were assessed using the Disabilities of the Arm, Shoulder, and Hand (DASH) or Lower Extremities Functional Scale (LEFS), and visual analog score (VAS). Serial radiological images were also assessed using Tiedeman and Lane-Sandhu scoring to determine union. Follow up assessments were performed every three months for at least 12 months or until clinical and radiological union was achieved. Results: Four (50%) out of eight subjects developed union in a median of five (3-12) months. There was a reduction of VAS, from a median of 1 (0-6) to 0 (0-4), and an increase in mean LEFS/DASH of 56.25 ± 10.71 to 65 ± 22.72. However, the infection was identified in 3 (37.5%) subjects. Methicillin-resistant Staphylococcus aureus (MRSA) was identified in two (25%) subjects, while one was infected with Escherichia coli . No other adverse events occurred during the follow-up period. Conclusion: Allogenic MSC implantation can be used as a potential and safe therapy for fracture non-union. However, the presence of infection may interfere with bone healing; thus, thorough eradication of infection must be ensured to achieve fracture union. Further clinical studies are required to investigate the safety and efficacy of allogeneic MSC implantation.

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“…Resection of sclerotic ends of pseudoarthrosis is usually done in treatment of CPT. Removing more tapered bone ends assume better cross sectional bone, better mechanical stress, chances of union and less chances of refracture [17] . Choe et al observed narrow tibial shaft unite with wide proximal metaphysis has increased refracture regardless of age [16] .…”

Section: Discussionmentioning

confidence: 99%

Outcome of Congenital Pseudoarthrosis Tibia Treated with Illizarov Fixator in Children

Khan

Javaid

Zafar

et al. 2020

International Journal of Orthopaedics

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What Factors Influence Union and Refracture of Congenital Pseudarthrosis of the Tibia? A Multicenter Long-term Study

Abstract: A larger sample is needed to confirm which factors truly influence the outcome of CPT. This may be feasible if data are collected prospectively through a multicenter registry.

Cited by 28 publications

References 25 publications

Congenital pseudarthrosis of the tibia: Biological and biomechanical considerations to achieve union and prevent refracture

Congenital pseudarthrosis of the tibia: Biological and biomechanical considerations to achieve union and prevent refracture

Incomplete Eradication of Persistent Infection May Impede Union: Our Experience in Treating Fracture Non-Unions with Allogenic MSC

Outcome of Congenital Pseudoarthrosis Tibia Treated with Illizarov Fixator in Children

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