Combination of the Ilizarov Method and Intramedullary Fixation for the Treatment of Congenital Pseudarthrosis of the Tibia in Children: A Retrospective Observational Study

Abstract

PurposeCongenital pseudoarthrosis of the tibia (CPT) is a rare disease in children, and its treatment remains a challenge for orthopedic surgeons. The purpose of this study was to evaluate treatment outcomes of patients with CPT treated by using the Ilizarov method combined with intramedullary fixation.MethodEighteen patients evaluated retrospectively from January 2009 to January 2020 were treated using the Ilizarov method combined with intramedullary fixation. Demographic data, clinical characteristics, and complications were all recorded and investigated during the period of follow-up. Ankle function was evaluated by the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores at the last follow-up.ResultThe average follow-up was 39.2 months (25–85 months) for all 18 patients. The mean age was 6.2 years (3.5–11.2 years). Fourteen (77.8%) patients had a primary bone union at the site of pseudarthrosis, while four obtained union after secondary surgical intervention. The mean duration of the Ilizarov method was 8.1 months (4.2–13.5 months). Eight (44.4%) patients had a pin-tract infection during treatment. Four (22.2%) patients had proximal tibial valgus with a mean angle of 12.1° (5–25°), while seven (38.9%) patients had ankle valgus deformities with a mean of 10.3° (5–20°). Eleven (61.1%) patients had an average 1.4 cm of limb length discrepancy (LLD) (0.6–3.1 cm) postoperatively. Five (27.8%) patients had refracture and recovered after a secondary surgery. At the last follow-up, the average postoperative AOFAS score was 72 (55–84).ConclusionThe Ilizarov method combined with intramedullary fixation is an effective method for the treatment of CPT, which can facilitate bony union and help to prevent refracture. Management of fibular pseudarthrosis is associated with functional outcomes. It is necessary to follow up until skeletal maturity and evaluate long-term clinical outcomes.

Treatment of Congenital Pseudarthrosis Tibia by Ilizarov Principle

“…Ankle valgus was a common postoperative complication, observed in 38.9% of patients with an average deformity of 10.3° (5-20°), attributed to inadequate lateral support from the distal fibula [10,11] . Andersen et al and Dobbs et al noted that despite over 50% of patients with fibula nonunion not showing ankle valgus, the condition often developed in those with fibular pseudarthrosis, evident in five of the seven individuals with ankle valgus in their study [12,13] .…”

“…The average postsurgery LLD was 1.4 cm (0.6-3.1 cm) in 11 patients, with minor LLDs treated non-surgically. Recent research has shown fibular pseudarthrosis's impact on refracture rates and ankle stability [10] , with Tudisco et al linking worse outcomes to fibular pseudarthrosis [17] . Persistent fibular pseudarthrosis was associated with tibial nonunion and increased ankle valgus [18] .…”

Physiotherapy Intervention Focusing on Proprioceptive Retraining for Tibial Pseudoarthrosis Patients Operated With Ilizarov External Fixator: A Case Report

“…Congenital pseudarthrosis of the tibia (CPT) is a rare condition that can manifest in an array of clinical presentations, from total non-union with severe bone abnormalities to simple anterolateral tibial angulation [3]. The pathogenesis of this condition demonstrates either lower osteogenic capability of the bone due to deficiencies in the local ability to vascularize the bone or greater osteoclastic action due to abnormalities in signalling [4].…”