Congenital Pseudarthrosis of the Tibia Treated by Free Vascularized Fibula Graft

Congenital pseudarthrosis of the tibia (CPT) remains one of the most difficult conditions to treat in pediatric orthopaedic surgery. Reported here were the results of free vascularized fibula grafts (VFG), describing the problems and the optimal approach.

From 1984 to the present, the authors performed VFG for 10 patients with CPT. In 4 cases, they reconstructed only the tibia. In the remaining 6, they simultaneously reconstructed the affected tibia and ipsilateral fibula with a folded VFG to prevent valgus ankle. Although casts or unilateral external fixators were applied, the graft sometimes fractured. Therefore, in recent cases, an Ilizarov external fixator was used for immobilization to increasebone hypertrophy and improved incorporation of the graft.

In 7 cases, the mean follow–up duration was 17 years (range, 12 to 21 years); in 2 cases, it was 4.8 years; and in the remaining case, it was 1.7 months. Good bony union of the tibia and the graft was achieved within 2 months in all but 3 cases, in which additional bone grafts resulted in bony union at 9, 28, and 33 months, respectively. At present, seven of the patients can walk without a brace and the remaining 3 patients use one. On average, a brace was required for 17months (range, 9 to 36 months).

Based on the clinical courses of these cases, the authors thought the most important point was reconstruction of the tibia in proper alignment and with enough strength mechanically. They recommended simultaneous reconstruction of the affected tibia and ipsilateral fibula, with the use of an Ilizarov external fixator for CPT. However, to achive union between the grafted fibula and recipient fibula was still difficult.