EC Orthopaedics

Introduction: Congenital pseudoarthrosis of the tibia is a rare disease. It can be defined as a disorder of the diaphysis which is disclosed by either pseudarthrosis at birth or by a pathological fracture presenting in bone with bowing, narrowing of the medullary canal or a cyst.

Internal fixation with intramedullary rodding, external fixation mainly by Ilizarov, combination treatment with an Ilizarov and rodding construct and vascularized fibula transfer, have been most widely used, which are traditionally described as achieving the best rates of union.

Refracture and non-union are the most serious complications that interferes with function, and may result in persistence of the pseud-arthrosis. Repeated surgeries due to failures of treatment lead to prolonged repeated disability, interruption of childhood and in some cases a recommendation for amputation.

Patients and Methods: This retrospective study, we reviewed the records of 24 children treated between 2001 and 2014. Who had presented with atrophic congenital pseudarthrosis of the tibia (Crawford type 4) as a refracture after one or more surgical intervention to achieve union in pseudoarthrosis tibia. There were 13 girls and 11 boys. The affected site was in the distal third of the tibia in 19 patient and in the middle third in 5 patients.

Result: The patients presented at a mean age of (4) years (2.5 to 10) except for two patients who had presented on age of 14 and 15 years old. Of the 24 patients, 18 patients had been treated surgically at other hospitals and by another surgeons, and the remaining 6 patient had been treated by us. 13 patients had been treated by ilizarov method, 6 patients by intramedullary rod (two of them with bone graft) and the remaining 5 by vascularized fibular graft. The mean interval from the union to the re fracture occurrence of the last intervention was (3 or 4) months (range from 2.5m to 12m). The ankle movement was assessed before our procedure but in some cases.

Conclusion: A modified surgical technique that combines Ilizarov fixator with retrograde calcaneo tibial multiple wires in distal tibial refracture of congenital pseudarthrosis of the tibia have clearly shifted from only achieving union to preventing re fractures, especially as high rates of bony union of CPT have been achieved.

 Keywords: A Modified-Technique; Congenital; Pseudoarthrosis; Tibia

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