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.

The purpose of this study was to evaluate a group of children treated with Pavlik harness for developmental dysplasia of the hip (DDH) to determine early ultrasound characteristics that predict poor acetabular development after walking age. From a group of 487 infants with DDH, 55 met inclusion criteria of (1) ultrasound documentation of major neonatal hip instability, (2) treatment with Pavlik harness, and (3) a minimum of 4 years of follow-up. These 55 infants had 100 abnormal hips. Harness treatment alone was successful in treating 87 of 100 hips. Persistent or late acetabular dysplasia was defined from serial radiographs. At a mean follow-up of 5.3 years, 5 of the 87 (6%) were found to have sequelae (late acetabular dysplasia, avascular necrosis of the femoral head, or both). Three sonographic findings present on the initial ultrasound predicted late sequelae: (1) dynamic coverage index of 22% or less, (2) alpha angle less than 43 degrees, and (3) abnormal echogenicity of the cartilaginous roof on initial ultrasound. Abnormal echogenicity was the most specific single predictor of residual dysplasia (sensitivity 100% and specificity 88%). The structurally normal cartilaginous roof is non-echogenic except for a short triangular fibrous tip (the labrum). Pathologic cartilage becomes echogenic beyond the tip as hyaline cartilage becomes fibrous and deformed. In unstable hips that respond well to Pavlik harness treatment, it would appear that midterm acetabular development can be affected when early transformation of roof cartilage accompanies displacement and instability.

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