Ilizarov Treatment of Congenital Pseudarthrosis of the Tibia: A Multi-Targeted Approach Using the Ilizarov Technique

Choi, In Ho; Cho, Tae-Joon; Moon, Hyuk Ju

doi:10.4055/cios.2011.3.1.1

Cited by 39 publications

(40 citation statements)

References 36 publications

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“…The Ilizarov technique, first introduced in the western world in the 1980s, has been widely used for CPT and has gained acceptance in various centers (Choi et al 2011). This method allows treatment of not only the pseudoarthrosis but also LLD, angular tibial abnormalities, proximal fibular migration, and foot contractures (Plawecki et al 1990, Guidera et al 1997).…”

Section: Discussionmentioning

confidence: 99%

Congenital pseudarthrosis of the tibia treated with a combination of Ilizarov’s technique and intramedullary rodding

Agashe¹,

Song²,

Refai³

et al. 2012

Acta Orthopaedica

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Background and purpose Ilizarov’s technique and intramedullary rodding have often been used individually in congenital pseudarthrosis of the tibia. In this series, we attempted to combine the advantages of both methods while minimizing the complications.Methods We reviewed 15 cases of congenital pseudoarthrosis of the tibia (CPT) who were treated with a combination of Ilizarov’s apparatus and antegrade intramedullary nailing between 2003 and 2008. The mean age at surgery was 7.5 (3–12) years and the mean limb length discrepancy was 2.5 (1.5–5) cm. At a mean follow-up time of 4.5 (1.6–7.2) years after the index surgery, the patients were evaluated clinically and radiographically for ankle function (AOFAS score) and for malalignment, signs of union, limb length discrepancy, and complications.Results 14 patients achieved union, in 6 patients primary union and in 8 patients after secondary procedures. The AOFAS score improved from a preoperative mean of 40 (20–57) to 64 (47–75). The main complication was refracture in 1 patient, and non-union in 1 patient.Interpretation The combination of the Ilizarov technique and conventional antegrade intramedullary nailing was successful in achieving union with few complications, though this should be shown in long-term studies lasting until skeletal maturity.

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Section: Discussionmentioning

confidence: 99%

Congenital pseudarthrosis of the tibia treated with a combination of Ilizarov’s technique and intramedullary rodding

Agashe¹,

Song²,

Refai³

et al. 2012

Acta Orthopaedica

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“…Two patients were treated with plate and screw fixation, which resulted in a persisting pseudarthrosis. This treatment option has been abandoned by most authors for many years [15].…”

Section: Discussionmentioning

confidence: 99%

“…The treatment of CPT remains challenging [13], but the rate of primary union appears to have improved through the use of treatment methods, such as the Ilizarov technique [14][15][16][17], microvascular fibula transfer [18], intramedullary fixation [19], or a combination of these procedures. Regardless of the surgical method used, some form of resection of the pseudarthrosis is commonly recommended as part of the initial treatment [20].…”

Section: Introductionmentioning

confidence: 99%

Epidemiology and treatment outcome of congenital pseudarthrosis of the tibia

Horn

Steen

Terjesen

2013

Journal of Children's Orthopaedics

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Purpose Congenital pseudarthrosis of the tibia (CPT) is a rare disease. Epidemiological data are limited, and treatment of the condition is challenging. The purpose of our study was to gain epidemiological data on the incidence of CPT in Norway and to evaluate the treatment outcome of the disease. Methods During the period 1987–2006 22 patients with CPT were born in Norway (11 boys, 11 girls; mean age 15 years, age range 8–24 years) and are included in this study. During the same time period 1,183,380 live-births were registered by the Norwegian Birth Register. Primary surgical treatment was the Ilizarov method in 15 patients, intramedullary nailing in three patients, and plate osteosynthesis in two patients; two patients never developed a fracture and were treated with an orthosis. Results The incidence of CPT based on this period was 1:53,000. The rate of primary healing was 66 % for the Ilizarov group. Primary healing occurred in three patients treated with intramedullary nailing and in none of the patients treated with plate osteosynthesis. However, almost all patients required additional surgery due to refracture or deformity correction. Currently, all 12 skeletally mature patients are considered to be healed, whereas two of the skeletally immature patients are still under treatment. Conclusion The incidence of CPT in Norway seems to be notably higher than that based on epidemiological data from other studies. Primary healing rates are satisfactory when treated either with an Ilizarov device or intramedullary nailing. Refractures must be avoided, and alignment of the leg must be maintained. Healing is usually achieved before skeletal maturity. However, residual deformities are common.

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“…Деформации костей голени у детей с кВЛСКГ не исключение [5]. Однако в мировой литературе данные о применении чрескостного остеосинтеза для удлинения и коррекции деформации голени на фоне кВЛСКГ скудны [8][9][10]. Основная сложность при лечении детей с кВЛСКГ заключается в том, что выполнение остеотомии на вершине деформации невозможно, так как в большинстве случаев эта область поражена патологическим процессом и остеотомия с удлинением грозит рецидивом псевдоартроза [6].…”

Section: актуальностьunclassified

Treatment of deformities in patients with healed congenital pseudarthrosis of the tibia

Zakharjan

Анатольевна²,

Pozdeev

et al. 2018

Pediatr Traum Orthop Reconstr Surg

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Background. Correction of deformities and lengthening of the lower extremities in patients with healed congenital pseudarthrosis of tibia (cCPT) is associated with certain characteristics, difficulties, and complications. But even the restoration of the anatomy and length of the tibia does not solve the problem of further recurrence of the deformity. Aim. This study aimed to evaluate the results of the correction of deformities of the tibia in patients with congenital pseudarthrosis of the tibia after achieving union by using external fixation and guided growth. Materials and methods. The results of treatment of 19 patients with cCPT, aged 4–15 years, which were observed in the Department of the Turner Scientific Research Institute from 2013 to 2018 years, were analyzed. We analyzed the types of deformities before the stage of correction deformities, evaluated the accuracy of the correction deformities after two-level osteotomies of the tibia, and used ortho-SUv passive computer navigation. External fixation index and number of complications were also determined. The type and number of recurrence of deformities and the timing of their detection were analyzed. Results. On the basis of clinical classification, patients with cCPT had complex deformities of the affected lower limb. The accuracy of the correction of deformities was 84% at the end of the correction period. The amount of elongation was 4.5 ± 1.5 cm. The IEF was 64.3 ± 40.6 days/cm. After the end of the external fixation period, deformities recurred in 100% of cases. In 17 patients, temporary hemiepiphysiodesis of the tibial bones, the second stage, was performed. The accuracy of the correction was 100%. The period of correction ranged from 12 to 14 months. Discussion. In the literature, we found no studies investigating the accuracy of the deformity correction, the choice of the level of osteotomies in patients with cCPT. Considering these data and the experience of the senior author of the publication, we performed two osteotomies of the tibia, outside the consolidation zone of the pseudarthrosis. High accuracy of the correction deformities was achieved in conjunction with the use of the ortho-SUv frame. Conclusion. The analysis showed that the deformity relapsed in 100% of children as the child grows, regardless of the accuracy of the deformity correction in children after achieving union CPT. Hemiepiphysiodesis is an effective treatment for this complication.

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Ilizarov Treatment of Congenital Pseudarthrosis of the Tibia: A Multi-Targeted Approach Using the Ilizarov Technique

Cited by 39 publications

References 36 publications

Congenital pseudarthrosis of the tibia treated with a combination of Ilizarov’s technique and intramedullary rodding

Congenital pseudarthrosis of the tibia treated with a combination of Ilizarov’s technique and intramedullary rodding

Epidemiology and treatment outcome of congenital pseudarthrosis of the tibia

Treatment of deformities in patients with healed congenital pseudarthrosis of the tibia

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