Abstract
PURPOSE
To report the experience and evolution of treatment of Congenital Pseudarthrosis of the Tibia in a single surgeon, consecutive series of 19 patients.
METHODS
A retrospective case series review, with radiological assessment and functional outcome scores including the Activity Scale for Kids (ASK) and the Oxford Ankle Foot Questionnaire (OAFQ) Child & Teenager version. Patients were classified as per Boyd & Andersen. Alteration in the Tibial mechanical axis was compared pre-treatment and at last review.
RESULTS
The average follow up from presentation was 6.3 years, 7 patients had reached skeletal maturity. Union was obtained in 79% at the time of review with a mean time to union of an established pseudarthrosis of 15.2 months. 9 of 19 had an established diagnosis of Neurofibromatosis. 8 had a frank pseudarthrosis at presentation, 2 of which were present at birth. There were 3 re-fractures following treatment. One of the 19 required amputation after failed surgical treatment. Each patient had an average of 2.4 surgical procedures. 14 patients had either fixed or elongating rods, 10 had Ilizarov treatment. 2 have outstanding surgery planned.
CONCLUSIONS
A philosophy of treatment has evolved which produces acceptable results. Splintage is used for antero-lateral bowing with corrective osteotomies and rodding, without extensive bone or periosteal resection, for significant or progressive deformity or fracture. Ilizarov treatment is used for recalcitrant cases over the age of 6 years. The technique has evolved over time to include bone graft wraps and the use of Bone Morphogenic protein in combination with the Ilizarov technique. Patients have below population and age matched average scores for both the ASK and OAFQ.
