Use of an Intramedullary Rod for the Treatment of Congenital Pseudarthrosis of the Tibia

Dobbs, Matthew B.; Rich, Margaret M.; Gordon, Joel; Szymanski, Deborah A.; Schoenecker, Perry L.

doi:10.2106/00004623-200503001-00003

Cited by 35 publications

(56 citation statements)

References 3 publications

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“…The techniques [2][3][4][5][6][7][8] include electrical stimulation, autogenous bone graft, external fixator, intramedullary nailing, and contralateral and ipsilateral fibular transfer. Dobbs et al [3] obtained consolidation in 80% of cases treated with intramedullary fixation, but they observed refracture and rigidity of the ankle as complications. Similarly, Kim and Weinstein [6] obtained 75% consolidation.…”

Section: Discussionmentioning

confidence: 99%

“…Various techniques [2][3][4][5][6][7][8] have been described in the literature for the treatment of CPT, although there is no consensus among them. The most commonly used are intramedullary fixation, conventional bone graft, Ilizarov external fixator or uniplane fixator with or without bone grafting, and free fibular transfer.…”

Section: Introductionmentioning

confidence: 99%

“…The technical and biological difficulties in obtaining consolidation are common, regardless of the technique used. These include: failure to consolidate, recurrence of the anterolateral bowing, and refractures [2,3,6]. Free fibular transfer is today a common practice for the treatment of CPT, with good results; however, it requires trained surgeons and hospital support for microsurgery [4,7,8].…”

Section: Introductionmentioning

confidence: 99%

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Congenital pseudoarthrosis of the tibia – results of treatment by free fibular transfer and associated procedures – preliminary study

Iamaguchi

Fucs

Costa

et al. 2011

Journal of Pediatric Orthopaedics B

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We evaluated 16 children with congenital pseudoarthrosis of the tibia treated with contralateral fibular graft, with the aim to report the difficulties and clinical results in the affected limb after consolidation. Sixty-three percent of the children had characteristics of neurofibromatosis. Consolidation was achieved after the main surgery in 37%of patients, and the remainder, after multiple procedures. Consolidation time was longer for male patients. Refracture was observed in six patients and recurrence of the anterior bowing in six; four of these patients were submitted to correction. Four patients presented femur overgrowth. The average shortening of the affected leg was 3.6 cm. The proposed procedure leads to a long treatment course with many reoperations for correction of possible complications.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Congenital pseudoarthrosis of the tibia – results of treatment by free fibular transfer and associated procedures – preliminary study

Iamaguchi

Fucs

Costa

et al. 2011

Journal of Pediatric Orthopaedics B

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“…The Williams technique of transankle stabilization with a rod has provided the best surgical results in our center. 28 Residual ankle stiffness, growth disturbance to the distal tibia, ankle valgus, and lateral plantar nerve entrapment have been documented as complications of the procedure. 29 The possibility of fracturing at the tip of the nail during its distal migration or during removal or reinsertion is a concern with this procedure.…”

Section: Bone Graftingmentioning

confidence: 99%

Neurofibromatosis Update

Crawford

Schorry

2006

Journal of Pediatric Orthopaedics

123

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Type 1 neurofibromatosis (NF-1), also known as von Recklinghausen disease, is one of the most common human single-gene disorders, affecting at least 1 million persons throughout the world. It encompasses a spectrum of multifacted disorders and may present with a wide range of clinical manifestations, including abnormalities of the skin, nervous tissue, bones, and soft tissues. The condition can be conclusively diagnosed when 2 of 7 criteria established by the National Institutes of Health Consensus Development Conference are met. Most children with NF-1 have no major orthopedic problems. For those with musculoskeletal involvement, the most important issue is early recognition. Spinal deformity, congenital tibial dysplasia (congenital bowing and pseudarthrosis), and disorders of excessive bone and soft-tissue growth are the three types of musculoskeletal manifestitations that require evaluation. Statistics gathered from the Cincinnati Children's Hospital Neurofibromatosis Center database of 588 patients show the incidence of spinal deformity in children with NF-1 to be 21%; pectus deformity, 4.3%; limb-length inequality, 7.1%; congenital tibial dysplasia, 5%; hemihypertrophy, 1.4%; and plexiform neurofibromas, 25%. The orthopedic complications can be managed, but only rarely are they cured. Current developments in molecular genetics are exciting and give hope to more positive outcomes.

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“…14 Among them, shortening of the affected tibia is one of the most frequently encountered problems during the treatment of CPT. 1 It may result from chronic resorption of bone tissue at pseudoarthrosis, inhibited growth of the distal tibial physis during the pseudarthrotic state, and repeated surgical resection and scarring. One of the advantages of the Ilizarov method in the treatment of CPT is that it can lengthen tibiae proximally and concomitantly obtain bony union of pseudarthrosis.…”

mentioning

confidence: 99%

Proximal Tibial Lengthening by Distraction Osteogenesis in Congenital Pseudarthrosis of the Tibia

Cho

Choi

Lee

et al. 2007

Journal of Pediatric Orthopaedics

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The purposes of this study were to investigate the outcome of distraction osteogenesis (DO) at the proximal tibial metaphysis in congenital pseudarthrosis of the tibia (CPT) patients and to identify the risk factors of poor regenerate bone formation. Twenty-seven cases of DO in 22 patients with CPT, with average age of 7 years, were divided into 2 groups. Group 1 contained those cases in which the target length was achieved with a healing index (HI) of 65 d/cm or less, and group 2 contained those with an HI of more than 65 d/cm and those that received additional procedures to achieve bone healing. Clinical and radiological parameters were analyzed and compared between the 2 groups using the Mann-Whitney U test or Fisher exact test. Ten cases were assigned to group 1, with a mean HI of 39 d/cm, and 17 to group 2 with a mean HI of 117 d/cm. Autogenous bone grafting was additionally performed in 12 cases, bone marrow injection in 4 cases, and demineralized bone matrix insertion in 1 case in group 2. Those cases showing proximal tibial dysplasia on radiograms (11 cases) or that underwent repeated lengthening (6 cases) belonged to group 2. The HI was significantly smaller in cases having neither of these 2 factors as compared with those having any of these factors. The present study shows that proximal tibial lengthening by DO in CPT can be safely performed if the proximal tibia is not dysplastic and has not been lengthened previously and that lengthening at a dysplastic proximal tibial segment or at a previously lengthened segment renders delayed healing and may require additional procedure(s) to promote bone healing. Physeal distraction or DO through subphyseal osteotomy may be justified to gain length in this high-risk group.

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Use of an Intramedullary Rod for the Treatment of Congenital Pseudarthrosis of the Tibia

Cited by 35 publications

References 3 publications

Congenital pseudoarthrosis of the tibia – results of treatment by free fibular transfer and associated procedures – preliminary study

Congenital pseudoarthrosis of the tibia – results of treatment by free fibular transfer and associated procedures – preliminary study

Neurofibromatosis Update

Proximal Tibial Lengthening by Distraction Osteogenesis in Congenital Pseudarthrosis of the Tibia

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