Dana Ger, B.S.
Alok Shah, M.D., S. Jay Kumar M.D.
Alfred I. duPont Institute
1600 Rockland Road
Wilmington, Delaware 19803
INTRODUCTION: Results following treatment of congenital pseudoarthrosis of the tibia are dismal. The purpose of this study was to determine: 1. The long term results following treatment, 2.The appropriate age for treatment, 3. The appropriate type of treatment.
MATERIALS AND METHODS: Only patients over ten years of age were included. Seventeen patients were identified. An average of 2.6 procedures were performed before union was achieved. In ten patients, the first surgery was performed before the age of two years. The mean age for the last procedure for achieving union was 5.7 years. The final procedures before a definitive outcome was achieved with: 8 intra-medullary fixation with bone graft, 2 plating and bone grafting, 4 Ilizarov procedures. In three patients an internal electrical stimulator was used as an adjunct to internal fixation and bone grafting.
RESULTS: At the last follow-up, at a mean age of 14 years, a solid union was achieved and maintained in 15 of the 17 patients. Two patients underwent amputation. In one patient union at the pseudoarthrosis site was achieved but because of significant leg length discrepancy and foot deformity an amputation was performed. One patient had a persistent pseudoarthrosis.
CONCLUSION: We concluded that successful treatment of congenital pseudoarthrosis of the tibia is possible. In our hands union was best achieved when the children were past five years of age. While I.M. fixation and bone grafting gave good results, plating and bone grafting had the least number of complications. For the future we have to concentrate on fibular healing and preventing of ankle valgus.
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