[3D-navigated high energy shockwave therapy and axis correction after failed distraction treatment of congenital...

The treatment of congenital tibial pseudarthrosis using a distraction procedure as described by Ilizarov is a standard surgical intervention. Nevertheless, there are problems in achieving bony stability in about 10% of cases even after repeated surgery as reported by Lammens et al. (2000). Traub et al. (1999) found a rate of 50% amputations in 33 cases treated since 1927. To prevent an Ilizarov procedure from resulting in a delayed union or nonunion, Paley et al. (1992) recommended autografting immediately after distraction. Based on the good results in the stimulation of osteogenesis in adults, we started to treat delayed bone union following distraction treatment with high-energy shock wave therapy also in children. In patients suffering from congenital tibial pseudarthrosis with a deviation of the bony axis, we combine this surgery-substituting therapy with fixation of a Taylor spatial frame in order to correct the axis. Using this new method of treatment, we were able to achieve stability in four children who previously had had nonunion even after multiple surgical interventions.