Combined surgery with 3-in-1 osteosynthesis in congenital pseudarthrosis of the tibia with intact fibula.

Abstract

BACKGROUND:

Re-fracture is the most serious complication in congenital pseudarthrosis of the tibia (CPT). There are reports that children with small cross-sectional areas in the sections of the pseudarthrosis are more prone to re-fracture. Presently, preventing complications is a challenge. Increasing the cross-sectional area in healed segments may reduce the incidence of re-fracture.

PURPOSE:

To elucidate the indications, surgical technique, and outcomes of combined surgery and 3-in-1 osteosynthesis in CPT with intact fibula.

METHODS:

We retrospectively assessed 17 patients with Crawford Type IV CPT with intact fibula (Type A) who were treated with combined surgical technique and 3-in-1 osteosynthesis between March 2014 and August 2015. The average age of the patients at the time of surgery was 3 years. Incidence of re-fracture, ankle valgus, proximal tibial valgus, and limb length discrepancy (LLD) were investigated over an average follow-up time of 47 months.

RESULTS:

Primary union was achieved in all patients. The average time for primary union was 4.9 months. Fifteen (88%) cases showed LLD with an average limb length of 1.6 cm; 6 (35%) cases exhibited tibial valgus with an average tibial valgus deformity of 7.8°; 2 cases had ankle valgus, wherein the ankle valgus deformity was 12° in one and 17° in another; and the cross-sectional area of the bone graft was enlarged to 1.74 times that of the tibia shaft. No case had re-fracture during the follow-up period. Movement of the ankle joint was restored in 16 patients with an average dorsiflexion of 22° and an average plantar flexion of 41°; the function of the ankle joint was normal. One patient had plantar flexion of 20° but did not have dorsiflexion.

CONCLUSION:

Combined surgical technique with 3-in-1 osteosynthesis, which is primarily considered for bone union with a large cross-sectional area, results in a high primary union rate. This can provide satisfactory results in short-term follow-up when treating CPT with intact fibula (Type A).

• Authors: Yaoxi Liu, Ge Yang, Kun Liu, Jiangyan Wu, Guanghui Zhu, Jin Tang, Yu Zheng, Haibo Mei
• Journal: Orphanet journal of rare diseases (Orphanet J Rare Dis) Vol. 15 Issue 1 Pg. 62 (03 02 2020) ISSN: 1750-1172 [Electronic] England
• PMID: 32122367 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Child
• Child, Preschool
• Fibula (surgery)
• Fractures, Bone
• Humans
• Pseudarthrosis (surgery)
• Retrospective Studies
• Tibia (surgery)
• Treatment Outcome