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Congenital pseudarthrosis of the tibia: the results of an evolving protocol of management
N Nicolaou1, A Ghassemi2, R A Hill2
1Maidstone and Tunbridge Wells NHS Trust, Maidstone, Kent UK.
Insights
This study evaluated a stepwise treatment protocol for congenital pseudarthrosis of the tibia, showing successful healing in most patients. The management approach, based on European Paediatric Orthopaedic Society (EPOS) guidelines, offers a less aggressive option for this complex condition.
Area of Science:
- Orthopaedic surgery
- Paediatric orthopaedics
Background:
- Congenital pseudarthrosis of the tibia is a challenging condition requiring effective management strategies.
- Existing treatments may involve aggressive limb reconstruction, particularly in young patients.
Purpose of the Study:
- To assess the outcomes of a management protocol for congenital pseudarthrosis of the tibia.
- To evaluate a stepwise approach based on European Paediatric Orthopaedic Society (EPOS) recommendations.
Main Methods:
- Retrospective cohort study of 11 patients treated with an incremental protocol.
- Interventions included bracing, intramedullary rods, and circular frame fixation, with optional bone morphogenetic protein-2 (BMP-2).
- Data collected included demographic information, pre- and post-treatment deformity parameters, and functional outcome scores.
Main Results:
- Successful healing of pseudarthrosis was achieved in 10 out of 11 patients.
- All deformity parameters showed improvement, with a mean leg length discrepancy of 2.5 cm at final follow-up.
- Refracture occurred in two patients and was associated with malalignment post-healing.
Conclusions:
- The evaluated stepwise protocol is an effective treatment for congenital pseudarthrosis of the tibia.
- This approach can help avoid aggressive limb reconstruction in some young patients.
- The findings support a structured, incremental management strategy for this complex paediatric orthopaedic disorder.
Purpose:
This retrospective cohort study assesses the outcomes of a protocol of management, based on the recommendations of the European Paediatric Orthopaedic Society (EPOS) multi-centre study, for the management of congenital pseudarthrosis of the tibia.
Methods:
Utilising an incremental protocol of bracing, intramedullary rods and circular frame fixation with or without bone morphogenetic protein-2 (BMP-2), 11 patients had reached skeletal maturity or had follow up of 5 years from radiological union of the pseudarthrosis. Demographic data, deformity parameters before and after treatment, and functional outcome scores were recorded.
Results:
Ten of the 11 patients successfully healed and two sustained a refracture. All deformity parameters improved and a mean leg length discrepancy of 2.5 cm (range 0-7.5 cm) existed at the time of the last follow up. Some pseudarthroses healed with deformity correction and rod insertion alone. Six of the 11 patients had a confirmed diagnosis of neurofibromatosis and nine had sustained a fracture before 4 years of age. Refracture was associated with malalignment after healing.
Conclusion:
This method of treatment provides a successful stepwise protocol for the management of this complex disorder, avoiding the use of aggressive limb reconstruction techniques at a young age in some cases. Level of evidenceCase series Level IV.
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