Cross-Union Surgery for Congenital Pseudarthrosis of the Tibia

Abstract

Congenital Pseudoarthrosis of the Tibia (CPT) is a rare condition with a reputation for recurrent fractures and failure to achieve union. A large variety of surgical procedures have been attempted for the treatment of fractured cases of CPT with an average rate of union without refracture of only 50%. Intentional cross-union between the tibia and fibula has been reported to improve these results to 100% union with no refractures. This is a retrospective study of 39 cases of CPT in 36 patients treated by the Paley cross-union protocol with internal fixation, bone grafting, zoledronic acid infusion and bone morphogenic protein 2 (BMP2) insertion. All 39 cases of CPT united at the tibia and developed a cross-union to the fibula. Two patients had a persistent fibular pseudarthrosis, one that was later treated at the time of planned rod exchange and one that has remained asymptomatic. There were few postoperative complications. There were no refractures during the up to 7-year follow-up period. The most common problem was the Fassier-Duval (FD) rod pulling through the proximal or distal physis into the metaphysis (66.7%). This did not negatively affect the results and was remedied at the time of the planned rod exchange. The Paley Cross-Union Protocol is very technically demanding, but the results have radically changed the prognosis of this once sinister disease.

Functional and radiological outcomes after treatment of congenital pseudarthrosis of the tibia using the Ilizarov technique: a retrospective single-center study

“…Congenital pseudarthrosis of the tibia (CPT) is a rare condition in children and is known for non-union and refractures. Besides achieving union and correcting deformities and limb length discrepancies (LLD), the goal of treatment is also to ensure a functional limb with minimal interventions [2][3][4].…”

“…Different surgical procedures can be used alone or in combination to treat CPT, such as intramedullary rods, vascularized fibular grafting, the Ilizarov technique, or the cross-union method. Successful surgery should achieve total excision of the lesion, deformity correction, bone healing promotion, and limb lengthening [3,[12][13][14].…”

“…CPT has variable and unpredictable outcomes and is known for non-union and refractures [2][3][4]. The etiology of CPT is unknown, although it was reported to be linked to neurofibromatosis-1 (NF-1) [2].…”

“…Besides achieving union and correcting deformities and LLD, the goal of treatment is also to ensure a functional limb with minimal interventions [2][3][4].…”

“…CPT can be surgically treated with different methods, including intramedullary rods or nails, vascularized fibular grafting, Ilizarov ring fixation, the cross-union method, or a combination of two or three techniques [3,4,[12][13][14].…”