Abstract
CPT is a rare disorder often leading to multiple surgical procedures in an attempt to achieve union but frequently ending in amputation.
The author presents a personal series of four cases (ages 3 + 4, 3 + 4, 4 + 3, 7 + 9 years) three of which had had a total of ten previous procedures. All patients underwent removal of previous fixation, excision of the abnormal periosteal tissue, freshening of the bone ends and “ram rodding” together under compression with the application of an lIizarov frame. A separate proximal osteotomy was performed for lengthening. The non-union was grafted primarily at the time of fixator application. Following frame removal a custom made telescopic nail was inserted in the three most recent cases. Average frame time was 263 days (184–301). All four cases have healed primarily and remain healed (19, 28, 31 and 70 months) post frame removal. The case not treated with a nail underwent bending of the proximal regenerate bone and required a second osteotomy to correct the deformity. Other than pin infections managed by antibiotics and local cares, the only other complication was the backing out of a cross-locking wire from the IM nail which required reinsertion.
The use of the llizarov frame enables a radical excision of pathological tissue and rigid compression of the non-union with concurrent restoration of limb length. The telescoping rod that is locked in the epiphyses proximally and distally enables normal rehabilitation of the joints without the need for prolonged bracing. The ongoing success of this treatment has encouraged the author to recommend it as the primary management for established congenital pseudarthrosis of the tibia.
Correspondence should be addressed to the editorial secretary: Associate Professor Jean-Claude Theis, Department of Orthopaedic Surgery, Dunedin Hospital, Private Bag 1921, Dunedin, New Zealand.
