Treatment of Congenital Pseudarthrosis of the Tibia

Кутиков, С. А.; Borzunov, D.Yu.; D'yachkova, G. V.; Chevardin, A. Y.

doi:10.24884/0042-4625-2016-175-4-53-58

Cited by 3 publications

(2 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…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].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

et al. 2022

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

“…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].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2022

View full text Add to dashboard Cite

show abstract

The Current State of Diagnosis and Treatment of the Congenital Tibia Pseudoarthrosis

Khmyzov¹,

Katsalap²

2021

OTP

View full text Add to dashboard Cite

Congenital pseudarthrosis of the tibia (CPT) is a rare disease that is detected with a frequency of 1 in 140–250,000 newborns. The disease is characterized by a wide range of clinical and radiological signs from progressive antecurvature deformation of the tibia to nonunion with a significant bone defect. Changes in the CPT area are caused by the influence of pathologically altered periosteum, which forms a fibrous hamartoma and is responsible for the deformityof the biomechanical properties of bone tissue. CPT can be formed at the moment of birth or developed spontaneously or as a result of minimal trauma in the early years. The main method of treatment of CPT is a surgery. Nowadays a number of surgical techniques, which are actively used and improved by specialists in the world, has been developed, The most used methods are the Ilizarovʼs method, application of intramedullary fixators, techniques with the use of vascularized tibial autograft, «induced membrane» technique. However, there are a few studies on comparing the effectiveness of different techniques or metal fixatives, most of them are presented in the format of a retrospective analysis of clinical cases series. This is due to the rarity of the disease and the lack of unified approaches on the choice of surgical treatment techniques. The main aim of surgical treatment of CPT is to achieveconsolidation in the area of pseudoarthrosis, which may restore the limb resistance. The part of primary consolidation of CPT after using the surgical treatment various techniques varies very much, range from 60 to 100 %. The percentage of children with CPT tibial amputations has decreased significantly over the past 30 years, which generally indicates an improvement of the results of surgical treatment of the mentioned pathology. However, CPT still remains one of the most difficult diseases of pediatric orthopedics due to the large number of unsatisfactory results and complications after surgery.

show abstract

Microsurgical autologous ffbula transfer as an optimal method for closure of extensive bone defects in children with neuroffbromatosis

Golyana,

Tikhonenko,

Galkina

et al. 2023

jour

View full text Add to dashboard Cite

Introduction Pseudarthrosis and bone defects are the most common consequence of neurofibromatosis type I in children, a rare hereditary disease. Destruction of bone tissue leads to severe deformities and impaired function of the limbs. Disability in such patients may reach 70 %. Surgical treatment of children with this pathology is long, laborious and multi-stage. Traditional orthopaedic methods for managing bone defects are often ineffective. The development of microsurgical methods enables to perform bone transfer of blood-supplied bone autografts.Purpose To prove the effectiveness of using microsurgical autologous transfer of the vascularized fibula for plastic surgery of bone defects in children with neurofibromatosis type I.Materials and methods A retrospective monocenter study included 27 pediatric patients who underwent reconstruction of bone defects with a vascularized fibular autograft from 2011 to 2021. The etiology of the bone defect in all patients was neurofibromatosis type I. A fibula graft was used to reconstruct 8 tibiae and 19 forearms. Bone defects averaged 12 cm. Median follow-up was 60 months.Results The fibula graft survival rate was 100 %. In 5 cases, nonunion of the proximal part of the fibula and the recipient zone was obtained which required iliac crest grafting. The overall rate of good and excellent results was 74 %. The average time to consolidation was 3 months. Discussion According to the literature, the use of autografting of vascularized bone fragments is a ather limited procedure in children with neurofibromatosis type I as it is associated with an increased risk of complications. Due to the restoration of blood flow in the transferred vascularized autograft, it retains its viability and the possibility of bone tissue remodeling.Conclusion Microsurgical autologous transfer of a vascularised fragment of the fibula is an effective and at times indispensable method of bone plasty in long bone defects in children with type 1 neurofibromatosis. Bone defects larger than 5 cm are an indication for free autologous transfer of a vascularized fragment of the fibula. This method, used in combination with traditional orthopedic methods for the treatment of children, allows obtaining good anatomical and functional results.

show abstract

Treatment of Congenital Pseudarthrosis of the Tibia

Cited by 3 publications

References 17 publications

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

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

The Current State of Diagnosis and Treatment of the Congenital Tibia Pseudoarthrosis

Microsurgical autologous ffbula transfer as an optimal method for closure of extensive bone defects in children with neuroffbromatosis

Contact Info

Product

Resources

About