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Experience with free fibula transfer with screw fixation as a primary modality of treatment for congenital pseudarthosis of tibia in children - Series of 26 cases
21 November 2019 (online)
Background: Congenital pseudarthrosis is one of the greatest challenges of paediatric orthopaedic practice. Treatment options and literature addressing this condition are numerous, reflecting the difficulty in management. We aimed to study the effectiveness of free fibula transfer as a primary modality of treatment in children with this condition in terms of achieving length, union, and normal axis of the involved leg. Materials and Methods: During the period of 2001 to 2010, 26 children with congenital pseudarthrosis of tibia between age group of 2-8 years were evaluated and were reconstructed using contra-lateral free fibula graft, and then patients were followed up for 5 years subsequently. Patients were examined and time of bony union, weight bearing ability and walking without support were noted. Any complication directly or indirectly related to surgery with any complication seen in the due course of follow up of 5 years was also taken care of. Results: In our experience with treatment of congenital pseudarthrosis over a span of 10 years with free fibula transfer, the results have been gratifying with no flap loss. All our patients had UNEVENTFUL post-op recovery. Only 2 patients out of 26 had non-union, for which cancellous bone grafting was done (7.6%). Most of the patients were ambulatory with support by 3-6 months and continued to walk without support after a span of 18-24 months. The incidence of stress fracture in our study over the follow-up period was 4 out of 26 pts (15.3%). None of them had any deformity in the donor leg. Conclusion: When compared to other surgical modalities of treatment of the problem in question, vascularised free fibula transfer has emerged as a real saviour with good patient compliance and less complication rate in our study. It achieves the desired target with no residual deformities and near normal to normal gait with no stigma of bone removal from other leg.
- 1 Santanelli F, Grippaudo FR, Paolini G, Renzi LF. Lower Extremity Reconstruction, Tibia Available from: http://www.emedicine.com. [Last updated on 2008 June 28]
- 2 Herring JA. Tachdjians′s Pediatric Orthopaedics. 3 rd ed. Philadelphia: WB Saunders; 2001.
- 3 Boyd HB. Pathology and natural history of congenital pseudarthrosis of the tibia. Clin Orthop 1982;166:5-13.
- 4 McCarthy RE. Amputation for congenital pseudarthrosis of the tibia. Clin Orthop 1982;166:58-61.
- 5 Berkshire SB Jr, Maxwell EN, Sams BF. Bilateral symmetrical pseudarthrosis in a newborn. Radiology 1970;97:389-90.
- 6 Roach JW, Shindell R, Green NE. Late-onset pseudarthrosis of the dysplastic tibia. J Bone Joint Surg Am 1993;75:1593-601.
- 7 Clifford R. Wheelers CR 2 nd . Wheelers Textbook of Orthopaedics, North Carolina, Data trace internet publishing, LLC. Copyright 1996-2011.
- 8 Crawford AH. Neurofibromatosis in children. Acta Orthop Scand 1986;218:1-60.
- 9 Van Nes CP. Congenital Pseudarthrosis of the Leg. J Bone Joint Surg 1966;48-A:1467-83.
- 10 Jacobsen ST, Crawford AH, Millar EA, Steel HH. Syme Amputation in Patients with Congenital Pseudarthrosis of theTibia. J Bone Joint Surg 1983;65:533-7.
- 11 Aitken GT. Amputation as a treatment for certain lower-extremity congenital abnormalities. J Bone Joint Surg 1959;41:1267-85.
- 12 Weber M. Neurovascular calaneo-cutaneous pedicled graft for stump capping in congenital pseudoarthrosis of tibia: Preliminary report of a new technique. J Pediatr Orthop 2002;11:47-52.
- 13 Guille JT, Kumar SJ, Shah A. Spontaneous union of a congenital pseudarthrosis of the tibia after Syme amputation. Clin Orthop Relat Res 1998;351:180-5.
- 14 Bassett CA, Caulo N, Kort J. Congenital pseudarthroses of the Tibia: Treatment with pulsing electromagnetic fields. Clin Orthop Relat Res 1981;154:136-48.
- 15 Brighton CT, Friedenberg ZB, Zemsky LM, Pollis PR. Direct-current stimulation of non-union and congenital pseudarthrosis-exploration of its clinical application. J Bone Joint Surg 1975;57:368-77.
- 16 Boyd HB. Congenital pseudarthrosis-treatment by dual bone grafts. J Bone Joint Surg 1941;23:497-515.
- 17 Mcfarland B. Pseudarthrosis of the tibia in childhood. J Bone Joint Surg 1952;3336-46.
- 18 Guidera KJ, Raney EM, Ganayt, Albani W, Pugh L, Ogden JA. Ilizarov treatment of congenital pseudarthrosis of the tibia. J Pediatr Orthop 1997;17:668-74.
- 19 Paley D, Catagni M, Argnani F, Prevot J, Bell D, Armstrong P. Treatment of congenital pseudoarthrosis of the tibia using the Ilizarov technique. Clin Orthop Relat Res 1992;280:81-93.
- 20 Boero S, Catagni M, Donzelli O, Facchini R, Frediani PV. Congenital pseudarthrosis of the tibia associated with neurofibromatosis-1: Treatment with Ilizarovs device. J Pediatr Orthop 1997;17:675-84.
- 21 Grill F, Bollini G, Dungi P, Fixsen J, Hefti, Ippolito E. Treatment approaches for congenital pseudarthrosis of the tibia: Result of the EPOS multicentre study. J Pediatr Orthop 2000;9:75-89.
- 22 Rose RE, Wright DE. Treatment of congenital pseudarthrosis of the tibia with the Ilizarov technique- A case report. West Indian Med J 2007;56:294-9.
- 23 Charnley J. Congenital pseudarthrosis of the tibia treated by the intramedullary nail. J Bone Joint Surg 1956;38:283-90.
- 24 Enneking WF, Eady JL, Burchardt H. Autogenous cortical bone grafts in the reconstruction of segmental skeletal defects. J Bone Joint Surg Am 1980;62:1039-58.
- 25 Ostrup LT, Fredrickson JM. Distant transfer of a free, living bone graft by microvascular anastomoses- An experimental study. Plast Reconstr Surg 1974;54:274-85.
- 26 Chen CW, Yu ZJ, Wang Y. A new method of treatment of congenital pseudarthrosis of the tibia using free vascularised fibula graft- A preliminary report. Ann Acad Med Singapore 1979;8;465-73.
- 27 Coleman SS, Coleman DA. Congenital pseudoarthrosis of the tibia: Treatment by transfer of ipsilateral fibula with vascular pedicle. J Pediatr Orthop 1994;14:156-60.
- 28 Ghanem I, Damsim JP, Carlioz H. Ilizarov′s technique in treatment of congenital pseudarthrosis of the tibia. J Pediatr Orthop 1997;17:685-90.
- 29 Poul J, Vesely J, Gal P. Treatment of congenital pseudarthrosis of the tibia using vascularised fibula graft. Acta Chir Orthop Trauma 2006;73:10-7.
- 30 Gilbert A. Vascularized fibular transfer for treatment of congenital pseudarthrosis. Read at the Annual meeting of the American Academy of Orthopaedic Surgeons, Anaheim, California, March, 1983.
- 31 Korompilias AV, Lykissas MG, Soucacos PN, Kostas I, Beris AE. Vascularized free fibular bone graft in the management of congenital tibial pseudarthrosis. Microsurgery 2009;29:346-52.
- 32 Weiland AJ, Weiss AP, Moore JR, Tolo VT. Vascularized fibular grafts in the treatment of congenital pseudarthrosis of the tibia. J Bone Joint Surg 1990;72:654-62.