Complex treatment of congenital pseudarthrosis of the tibia with periosteal grafting and intramedullary fixation
Journal Title: Postępy Nauk Medycznych - Year 2012, Vol 25, Issue 6
Abstract
<b>Introduction.</b> In the last years to improve the outcomes of congenital pseudarthrosis of the tibia (CPT) treatment, new procedures were added to the standard: periosteal grafting, bone morphogenic protein (BMP) and bisphosphonate. In this study we analyze results of CPT treatment with periosteal graft combined with intramedullary nailing.<br><b>Materials and methods.</b> Retrospective study of medical records and the radiographs of 7 patients treated because of CPT with resection of the hamartomatous periosteum, splitting of proximal tibial end or pseudarthrosis site resection, IM fixation, periosteal and cancellous bone grafting from the iliac bone was made. Mean age at the surgery was 5.6 years. Six patients had NF-1 and one patient – idiopathic CPT. LLD ranged 1.0-10.0 cm (average 4.7). The anteroposterior preoperative scan of all patients were studied for assessments of ankle joint mortise, where proximal migration of the fibula was evaluated according to Malhotra scale for fibular shortening. The patients were classified according to El-Rosasy-Paley classification: 2 patients as type I, and 5 patients as type II. All of them were type IIC according to Crawford classification. The average follow-up after the index operation was 3.1 years (range 2.1-4.6).<br><b>Results. </b>Primary pseudarthrosis union of the tibia was achieved in 6 patients, at a mean time of four and half months (range 4-6 months). Failure to obtain bone union after 13 months in youngest patient needs reoperation with the same technique.<br><b>Conclusions. </b>Primary union of CPT in most of the cases can be obtained and maintained with limited pseudarthrosis resection, periosteal and cancellous bone grafting and intramedullary rod fixation.
Authors and Affiliations
Milud Shadi, Paweł Koczewski
Keywords
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