Intramedullary fixation and bone grafting for congenital pseudarthrosis of the tibia

Eleven consecutive patients with 12 congenital pseudarthroses of the tibia had intramedullary fixation and autogenous bone grafting as an initial treatment. None of these patients had previous surgeries or other concomitant procedures. The average age of the patients at the time of surgery was 2.5 years (range, 0.5-8.8 years). Four patients achieved initial union after the first index operation; two patients achieved union with no additional procedures, and three patients required an exchange intramedullary fixation for persistent nonunion after refractures that eventually healed. Seven patients did not achieve union after the first index operation; four patients achieved healing after multiple procedures including repeat intramedullary fixation, free vascularized fibular grafting, or both; two patients eventually had below-knee amputations after multiple procedures failed; and one patient did not achieve union of the pseudarthrosis. The important factors leading to failure of union were the distal location of the tibial pseudarthrosis and the presence of concomitant pseudarthrosis of the fibula.