Surgical treatment options for congenital pseudarthrosis of tibia in children: cross-union versus other options: a systematic review

Rastogi, Ashu; Agarwal, Anil

doi:10.1097/bpb.0000000000000924

Cited by 10 publications

(7 citation statements)

References 80 publications

(209 reference statements)

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“…In addition, significant LLD was observed in only one case in our study, which is similar to the result of Laine et al, and contrary to the results observed with other treatment methods. 1,28 This supports the interpretation of Laine et al 5 who contend that LLD is not an inherent risk of CPT but may be iatrogenic or secondary. All these results strengthen our confidence to manage CPT treatment by preventing fracture, decreasing tibial malalignment, improving radiographic appearance of bone quality, and preserving leg length.…”

Section: Discussionsupporting

confidence: 72%

“…In terms of patient outcomes, a published systematic review concluded that the mean primary union rate in series using IMR was 67.7% and there was high non-union (17%) and refracture rate (48.1%). 28 The Ilizarov external fixator, which was proposed in the early 1970s, is capable of producing rigid and controlled fixation for compression, distraction, bone transport to the resection defect, lengthening, deformity correction, and union. 29 The overall union rate for the Ilizarov method in literature ranges from 60%–100%.…”

Section: Discussionmentioning

confidence: 99%

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Preventing of nonunion in congenital pseudarthrosis of the tibia cases of Crawford Type I and II through the use of allograft bypass and a brace: Midterm findings

Dong,

Li,

Brückner

et al. 2024

Journal of Children's Orthopaedics

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Background: Congenital pseudarthrosis of the tibia is a limb deformity, which can be distressing for the affected patients and the pediatric orthopedic surgeons involved. We hypothesized that the modified McFarland procedure would avoid fractures and even have a corrective effect on the affected tibia in congenital pseudarthrosis of the tibia patients. Toward this end, we evaluated the midterm results of treating congenital pseudarthrosis of the tibia patients of Crawford Type I and II with allograft bypass combined with long-term bracing. Methods: This study retrospectively evaluated 7 patients with congenital pseudarthrosis of the tibia who were treated with allograft bypass combined with long-term bracing between 2009 and 2018. The median follow-up was 7.0 years (range 3.8–10.0 years). The medical records and radiographs were reviewed for demographic data, clinical characteristics, outcomes, and complications. Results: At the time of the last follow-up, all allografts revealed complete consolidation in the patients’ tibiae at both ends. All patients presented no functional restriction of the lower limbs and no amputation or non-union has occurred. Most of the obvious deformities of the tibia diaphysis or ankle joint were corrected. Two complications occurred that required successful revision surgery. Conclusion: In this series of seven congenital pseudarthrosis of the tibia patients, the allograft bypass technique showed satisfactory midterm results and validated our hypothesis. For congenital pseudarthrosis of the tibia patients of Crawford Type I and II, this procedure combined with long-term bracing, which involves the affected leg only, can delay or possibly prevent fractures, decrease tibial malalignment, and preserve leg length. Level of evidence: level IV.

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Section: Discussionsupporting

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Preventing of nonunion in congenital pseudarthrosis of the tibia cases of Crawford Type I and II through the use of allograft bypass and a brace: Midterm findings

Dong,

Li,

Brückner

et al. 2024

Journal of Children's Orthopaedics

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“…Treating nonunions due to segmental bone loss in the radius and ulna is challenging. Although techniques such as bone transport with Ilizarov exist, this technique does not work in avascular bone after infection [22][23][24].…”

Section: Discussionmentioning

confidence: 99%

The Use of Free Fibula Flap in Different Extremities and Our Clinical Results

Atilgan

2023

Cureus

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Background and objectives Plastic, orthopedic, otolaryngology, and oromaxillofacial surgery specialists rely on fibula grafts to solve reconstructive problems. The aim of this study is to discuss the use and results of vascular fibula flaps in the treatment of bone and soft tissue defects in various regions with different etiologies. Materials and methods In our clinic, we treated 32 patients with osteocutaneous fibular flaps due to bone and soft tissue defects of different etiologies and varying anatomical regions. In our study, age, gender, side, cause of injury, surgical technique, treatment results, and complications were evaluated for each patient. Results Of the 32 patients, 25 were male, and 7 were female. The average age is 37.2 (27-56). The mean bone defect size was 10.45 cm. Bone defect occurred in eight patients due to osteomyelitis, eleven patients due to gunshot wounds, nine patients due to pseudoarthrosis, and four patients due to a giant cell tumor. We applied osteocutaneous fibula flap in 27 patients and vascularized fibular flap in five patients. Bone union could not be achieved in four patients, and bone grafting was performed as a secondary surgery. Local infection occurred in five patients, and their treatment was completed with debridement and antibiotic administration. Wound complications occurred in three patients at the donor site, which were treated with debridement and skin grafting. The mean duration of radiological union was three months, and complete union was achieved in the seventh month. Conclusions We have shown in our case series that free vascularized fibula transfer has gained an important place in the field of skeletal reconstruction and is a reliable method for various bone reconstructions.

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“…They also reported that the bone healing rate of 8 cases was 100% without a refracture, with an average follow-up of 7.4 years. Moreover, in a very recent meta-analysis of various surgical methods for the treatment of CPT, the results showed that cross-union achieved the best clinical results in both union rate (100%) and re-fracture rate (22.5%), which may be related to the increase of bone contact cross-sectional area [32]. Although the sample size of these reports was not very large, the results of 100% bone union were encouraging, which showed the importance of cross-union for CPT treatment.…”

Section: Discussionmentioning

confidence: 99%

Analysis of risk factors affecting union and refracture after combined surgery for congenital pseudarthrosis of the tibia: a retrospective study of 255 cases

Huang

et al. 2022

Orphanet J Rare Dis

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Background Congenital pseudarthrosis of the tibia (CPT) is a rare disease occurring in children. The aim of this study is to identify the factors affecting bone union and re-fracture after surgery for CPT and to provide reliable evidence for clinics. Methods We collected the detailed information of 255 cases with Crawford IV CPT treated by combined surgery in our hospital from 2013 to 2020. Basic characteristics were recorded. Univariate variance and logistic regression analysis were used to compare the correlations between factors and outcomes. Results 92.5% of patients achieved primary union, 7.5% of patients had non-union and 13.3% of patients had re-fracture. Logistic regression analysis showed that age at index surgery (Coef. = 0.171, 95%CI 0.015–0.327, P = 0.032), and CPT location (Coef. = − 1.337, 95%CI − 2.218–0.456, P = 0.003) had statistical differences, while no factors had significant correlation with re-fracture. Furthermore, ROC curve showed that the optimal age threshold for first surgery was 2.37 years old. Conclusions For patients with Crawford IV CPT treated by combined surgery, the younger the age at index surgery and the closer the CPT location to the distal end, the easier to achieve bone union.

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Surgical treatment options for congenital pseudarthrosis of tibia in children: cross-union versus other options: a systematic review

Cited by 10 publications

References 80 publications

Preventing of nonunion in congenital pseudarthrosis of the tibia cases of Crawford Type I and II through the use of allograft bypass and a brace: Midterm findings

Preventing of nonunion in congenital pseudarthrosis of the tibia cases of Crawford Type I and II through the use of allograft bypass and a brace: Midterm findings

The Use of Free Fibula Flap in Different Extremities and Our Clinical Results

Analysis of risk factors affecting union and refracture after combined surgery for congenital pseudarthrosis of the tibia: a retrospective study of 255 cases

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