Congenital Forearm Pseudarthrosis, a Systematic Review for a Treatment Algorithm on a Rare Condition

Area of Science:

• Orthopedic Surgery
• Pediatric Orthopedics
• Regenerative Medicine

Background:

• Congenital forearm pseudarthrosis is a rare condition, often linked to neurofibromatosis type 1.
• Optimal surgical treatment strategies remain unclear, necessitating a review of current evidence.

Purpose of the Study:

• To systematically review treatment options for congenital forearm pseudarthrosis.
• To develop a clinical decision-making algorithm for managing this condition.

Main Methods:

• Systematic review adhering to PRISMA guidelines, searching multiple databases (Embase, MEDLINE, etc.).
• Inclusion of English literature, with quality assessment using Joanna Briggs Institute critical appraisal checklist.
• Extraction of patient data, surgical techniques, union rates, and functional outcomes.

Main Results:

• 47 studies (84 cases) were included, analyzing various surgical interventions.
• One-bone forearm procedure demonstrated high union rates (92%) but resulted in loss of forearm rotation.
• Free vascularized fibula grafting showed high union rates (87%) with good functional outcomes in elbow flexion and forearm rotation.

Conclusions:

• Free vascularized fibula grafting is recommended as the primary treatment for congenital forearm pseudarthrosis.
• One-bone forearm procedure is best reserved as a salvage technique.
• The review provides sufficient evidence to formulate a treatment algorithm for pediatric clinical practice.