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

Abstract

Background Congenital pseudarthrosis of the tibia (CPT) is a challenging problem in orthopedic practice, with high rates of non-union, refracture, and residual deformities. After union, long-term follow-up is required to manage late post-union complications. This study aimed to assess the outcomes of the Ilizarov technique in the management of CPT. Materials and methods This retrospective study included patients with CPT treated with the Ilizarov method between 2005 and 2018. Intramedullary rods were used in 9 cases and iliac bone graft was used in 12 cases. An orthosis was applied till the end of follow-up in all cases. The American Orthopaedic Foot and Ankle Society (AOFAS) scale was used for the evaluation of the functional outcomes. Results This study included 16 patients, 11 males and 5 females, with an average age of 5.4 ± 2.8 years. Seven cases had multiple previous surgeries. Six patients had neurofibromatosis. The mean follow-up period was 5.8 ± 3.4 years. The average AOFAS score improved significantly from 47.5 ± 7.6 preoperatively to 78.9 ± 8.9 at the latest follow-up. Union was achieved in 15 cases, and persistent non-union occurred in one case. The clinical results were excellent in one patient, good in seven cases, fair in 6, and poor in 2 cases. The radiological results were excellent in one patient, good in seven cases, fair in seven, and poor in one case. Conclusions The Ilizarov technique combined with intramedullary rod and primary or secondary bone graft provides a high union rate of CPT and can achieve simultaneous effective management of problems related to pseudarthrosis, including non-union, deformity, limb shortening, and adjacent joint contracture and subluxation. Level of evidence Level IV.

Congenital Pseudoarthrosis of Tibia With Anterolateral Bowing Treated With Ilizarov Ring Fixator: A Case Report

“…No complications were observed in the index case during our follow-up duration of eight months after the procedure. However, longer-duration follow-ups were done in other studies (up to six years, until skeletal maturity) and reported varied complications and functional outcomes [11,12].…”

Treatment of Congenital Pseudarthrosis Tibia by Ilizarov Principle

“…All patients had unilateral limb involvement, café au lait spots, and were from lowincome backgrounds, with varied non-union types observed. Zayda et al [9] retrospectively analyzed sixteen CPT patients treated with segmental resection or the Ilizarov method, noting a mean age of 5.4 ± 2.8 years at the index operation. There was a slight majority of right-leg (56.2%) involvement over the left (43.8%), with patients having a history of 0 to 7 unsuccessful prior surgeries.…”

“…All patients were classified as type II Crawford, with 13.33% showing neurofibromatosis and an average leg length discrepancy of 7.4 ± 3.95 cm. Zayda et al [9] reported an average limb shortening of 3.6 ± 1.9 cm, classifying patients according to the El-Rosasy-Paley classification, and noted a high incidence of fibula dysplasia (81.3%). Preoperative gaps at the CPT site averaged 1.3 ± 1.0 cm, expanding to 6.1 ± 1.0 cm post-resection, with preoperative AOFAS scores ranging from 38-65.…”

“…A 15-year follow-up revealed one case of knee varus deformity. Pin tract infections were common but manageable with oral antibiotics and dressing changes, except for three severe cases requiring intervention [9] . Cho et al reported one non-union and 19 refractures among 43 patients treated with the Ilizarov technique [19] .…”

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

“…Various surgical approaches can be used to treat CPT, such as the cross-union approach, intramedullary rods or nails, vascularized fibular grafting, Ilizarov ring fixation, or a combination of two or three treatments. Regardless of the approach selected, surgery involves use of the same biological principles to rectify angular deformity, bone bridging of the defect, and pseudarthrosis excision [ 5 ]. However, residual difficulties are prevalent.…”