Treatment of Congenital Pseudoarthrosis of the Tibia Using the Ilizarov Technique

Paley, Dror; Catagni, Maurizio A.; Argnani, Favio; Prévot, J; Bell, Deborah F.; Armstrong, Peter F.

doi:10.1097/00003086-199207000-00011

Cited by 118 publications

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“…This condition is due to a high position of the fibular distal epiphysis and because of an asymmetric growth of the distal tibial physis that grows more medially than laterally [2,10]. In our study, five patients had a persistent pseudarthrosis of the fibula, but only three of these developed ankle valgus.…”

Section: Discussionmentioning

confidence: 55%

Association of Ilizarov's technique and intramedullary rodding in the treatment of congenital pseudarthrosis of the tibia

Laurent¹,

Vialle²,

Thévenin-Lemoine³

et al. 2008

Journal of Children's Orthopaedics

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Purpose Many surgical techniques have been published on how to treat congenital pseudoarthrosis of the tibia (CPT). We combined Ilizarov's fixator with intramedullary nailing of the tibia and developed a procedure which combines the advantages of both methods: Ilizarov's high fusion rate with alignment control and the protection against refracture provided by the intramedullary nail. The results of this approach are presented and discussed. Material and methods Seven boys and three girls aged 3-14 years (mean age 8 years 2 months) were treated using our combined technique. In six cases, the CPT was associated with neurofibromatosis. Two strategies were adopted: in six cases, a compression was applied on the bone defect, and in four cases, segmental bone transportation was performed before the compression procedure. The final follow-up (1.2-6.6 years) included a clinical and radiological examination. Results Tibial union was achieved in nine cases without bone grafting. In one case, tibial union still remains uncertain, despite intertibiofibular bone grafting and additional compression procedures. Thirteen overall complications were noted, including three valgus deformity of the ankle. Bone transportation failed to achieve complete limb lengthening in three cases. One deep infection occurred 4 years after removal of the external fixator. The treatment for this included nail removal and antibiotic therapy for 3 months. Despite a permanent protection of orthosis, a refracture occurred 2 years after nail removal, reverting to the initial level of pseudarthrosis. Another surgical attempt using the same method was then performed with a satisfactory result. Conclusions The association of Ilizarov's technique and intramedullary nailing achieved and maintained tibial union in nine of ten patients at final follow-up. It also allowed correction of axial deformities and prevented refracture. Despite the short duration of the follow-up and a high rate of complications in our series, this method can be useful in many cases of CPT in which healing has failed to occur despite many previous surgeries.

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Section: Discussionmentioning

confidence: 55%

Association of Ilizarov's technique and intramedullary rodding in the treatment of congenital pseudarthrosis of the tibia

Laurent¹,

Vialle²,

Thévenin-Lemoine³

et al. 2008

Journal of Children's Orthopaedics

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“…The purpose of this study is to evaluate a new technique in the treatment of CPT adapted to atrophic types. Today, the best results to achieve bone union have been reported using vascularized fibular grafting [8,9] and Ilizarov intercalary bone transport [10,11]. The transfer of healthy vascularized bone in the first case and increasing blood flow by proximal corticotomy and diaphyseal transfer in the second creates a favorable vascular environment for union while compensating for bone defects.…”

Section: Discussionmentioning

confidence: 99%

Induced membrane technique for the treatment of congenital pseudarthrosis of the tibia: Preliminary results of five cases

Pannier

Péjin

Dana

et al. 2013

Journal of Children's Orthopaedics

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Purpose The purpose of this study was to evaluate the two-stage surgical technique combining induced membrane, spongy autograft and intramedullary fixation for the treatment of congenital pseudarthrosis of the tibia (CPT). Methods Three boys and two girls were treated by this technique between 2003 and 2008. All patients had type IV CPT in Crawford's classification. Four of them had a limited dystrophic form, whereas one case presented an extensive tibia bone dystrophy. The average age of patients at the time of surgery was 23 months (range 10-30 months), with an average follow-up of 5.8 years (range 2.4-8.1 years). Results Satisfactory tibial bony union was achieved in all cases at the last follow-up. Bone healing was obtained in the four limited forms after an average term of 4 months. One patient suffered from a non-displaced fracture that healed by casting in a usual period of time. The patient with an extensive dystrophic bone had to undergo a secondary inter-tibiofibular bone graft to finally achieve bone union. Conclusions The preliminary results show that this technique is successful in CPT. It may be used even in young children and offers a good alternative to other treatments available, avoiding external fixation and the technical difficulties of microvascular surgery.

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“…Several treatments for congenital pseudoarthrosis of the tibia have been de- 1985), free vascularized fibular grafts (Hagan and Buncke 1982, Pho et al 1985, Weiland et al 1990), electrical stimulation (Bassett and Schink-Ascani 1991) and, recently, external fixation ( Paley et al 1992, Boero et al 1997, Ghanem et al 1997, Guidera et al 1997. Amputation remained a treatment option because success rates remained extremely low (Paterson 1989).…”

Section: Discussionmentioning

confidence: 99%

“…Amputation remained a treatment option because success rates remained extremely low (Paterson 1989). With the Ilizarov method (Paley et al 1992), 15/16 cases united, after the first treatment, and the remaining case after a second procedure, compared to about half the cases reported with other methods (Morrissy et al 1981, Hagan and Buncke 1982, Paterson and Simonis 1985, Pho et a1.1985.…”

Section: Discussionmentioning

confidence: 99%

Failed treatment of congenital pseudoarthrosis of the tibia—a case of llizarov-transportation of proximal tibia with arthrodesis to talus

Velan¹,

Katz²,

Hendel³

1998

Acta Orthopaedica Scandinavica

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Treatment of Congenital Pseudoarthrosis of the Tibia Using the Ilizarov Technique

Cited by 118 publications

References 0 publications

Association of Ilizarov's technique and intramedullary rodding in the treatment of congenital pseudarthrosis of the tibia

Association of Ilizarov's technique and intramedullary rodding in the treatment of congenital pseudarthrosis of the tibia

Induced membrane technique for the treatment of congenital pseudarthrosis of the tibia: Preliminary results of five cases

Failed treatment of congenital pseudoarthrosis of the tibia—a case of llizarov-transportation of proximal tibia with arthrodesis to talus

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