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Congenital pseudarthrosis of the tibia in children: should we defer surgery until 3 years old?
Yaoxi Liu1, Haibo Mei, Guanghui Zhu
1Department of Pediatric Orthopaedics, Hunan Children's Hospital, The Pediatric Academy of University of South China, Changsha City, Hunan Province, China.
Insights
Surgery for congenital pseudarthrosis of the tibia (CPT) in children under three years old yields comparable outcomes to older children. Early surgical intervention for CPT is effective and does not necessitate deferral until after age three.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Pediatric Bone Disorders
Background:
- Congenital pseudarthrosis of the tibia (CPT) is a rare condition characterized by the failure of the tibia to ossify.
- The optimal timing for surgical intervention in CPT remains a subject of debate among orthopedic surgeons.
- Early surgical treatment aims to achieve bone union and correct deformities, but concerns exist regarding potential complications in younger children.
Purpose of the Study:
- To evaluate the outcomes of surgical treatment for CPT in children younger than three years of age.
- To compare the incidence of postoperative complications between children younger than three and those older than three undergoing CPT surgery.
- To determine if delaying surgery for CPT until after three years of age is beneficial.
Main Methods:
- A retrospective study analyzed 42 patients with Crawford type IV CPT treated between 2008 and 2012.
- Patients were divided into two groups: Group A (<3 years) and Group B (>3 years).
- Outcomes assessed included primary bone union, refracture rates, ankle valgus, tibial valgus, and limb-length discrepancy.
Main Results:
- Primary bone union rates were high in both groups (97% in Group A, 92% in Group B), with no significant difference (P>0.05).
- Limb-length discrepancy showed a significant difference between groups (P=0.033), with a higher incidence in Group B (77%) compared to Group A (41%).
- While Group B had higher rates of refracture, ankle valgus, and tibial valgus, these differences were not statistically significant compared to Group A.
Conclusions:
- There is no significant difference in primary bone union rates between younger and older children undergoing CPT surgery.
- Limb-length discrepancy is more common in children operated on after three years of age.
- The study suggests that delaying surgery for CPT until after three years of age is not necessary and may lead to increased limb-length discrepancy.
Abstract:
Currently, the timing of surgery for congenital pseudarthrosis of the tibia (CPT) remains controversial. The aim of this study was to investigate the results of treatment of pseudarthrosis of the tibia in children younger than 3 years of age. A retrospective study was carried out to explore the relationship between postoperative complications and the age of surgery in children with CPT. The analysis was carried out on 42 patients with Crawford type IV CPT treated with a combined surgical technique between 2008 and 2012. Patients were divided into two groups according to their age: group A (<3 years) and group B (>3 years). The incidence rates of refracture, ankle valgus, tibial valgus, and limb-length discrepancy of the two groups were evaluated. Primary bone union was achieved in 28 out of 29 (97%) patients in group A and 12 out of 13 (92%) patients in group B (P>0.05). In group A, six (21%) patients developed a refracture; 14 (48%) patients had ankle valgus with a mean degree of 11° (range: 5°-25°); 11 (38%) patients had tibial valgus with a mean tibial valgus deformity of 8.6° (range: 5°-20°); and 12 (41%) patients had limb-length discrepancy with a mean limb length of 2.9 cm (range: 0.5-4 cm). In group B, five (38%) patients developed refracture; seven (54%) patients had ankle valgus with a mean degree of 14° (range: 5°-30°); seven (54%) patients had tibial valgus with a mean tibial valgus deformity of 10.7° (range: 5°-20°); and 10 (77%) patients had limb-length discrepancy with a mean limb length of 2.8 cm (range: 1.5-3 cm). Groups A and B were significantly different in limb-length discrepancy (P=0.033). This study suggests that there is no need to defer surgery for pseudarthrosis of the tibia until the child is older than 3 years of age.
