Related Experiment Video
Updated: Aug 11, 2026
Use of Human Perivascular Stem Cells for Bone Regeneration
Published on: May 25, 2012
Crawford Type IV Congenital Pseudarthrosis of the Tibia: Treatment With Vascularized Fibular Grafting and Outcome at
Tarek A El-Gammal1, Amr El-Sayed, Mohamed M Kotb
1Department of Orthopedics and Traumatology, Reconstructive Microsurgery Unit, Assiut University Hospitals and School of Medicine, Assiut, Egypt.
Insights
Vascularized fibular grafting (VFG) effectively treats congenital tibial pseudoarthrosis (CPT), with best outcomes in young children receiving intramedullary fixation. However, limb length discrepancy and ankle valgus increase with age, while tibial deformities require correction.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Limb Reconstruction
Background:
- Congenital tibial pseudoarthrosis (CPT) is a challenging condition.
- Vascularized fibular grafting (VFG) is a common treatment, but long-term functional outcomes can decline.
- Understanding long-term VFG results is crucial for CPT management.
Purpose of the Study:
- To evaluate the long-term outcomes of vascularized fibular grafting (VFG) in patients with congenital tibial pseudoarthrosis (CPT).
- To identify factors influencing the success and complications of VFG for CPT.
Main Methods:
- A retrospective review of 39 patients with CPT treated with VFG.
- Patients' age at surgery, previous procedures, graft size, and fixation methods were recorded.
- Follow-up averaged 8.1 years, assessing bone union, stress fractures, deformities, and limb length discrepancy.
Main Results:
- 96% achieved primary bone union, but 51.3% experienced stress fractures.
- Over 50% developed tibial shaft deformities and ipsilateral ankle valgus.
- Limb length discrepancy and ankle valgus increased with age until skeletal maturity.
Conclusions:
- Free VFG is an effective treatment for CPT, particularly when performed before age 3 with intramedullary fixation and no prior surgeries.
- Tibial deformities do not remodel and may require correction.
- Limb length discrepancy and ankle valgus progression necessitate careful monitoring until skeletal maturity.
Background:
Vascularized fibular grafting (VFG) is currently accepted as one of the best treatments for congenital tibial pseudoarthrosis (CPT). However, with longer follow-up, functional results deteriorate, and some problems become evident.
Methods:
Thirty-nine patients with CPT were treated with VFG. Their age at surgery averaged 5.2 years. Twenty-one cases aged 3 years or less at the time of surgery. All cases were Crawford type IV affected by neurofibromatosis-1. Fourteen patients had 1 to 7 previous surgeries with an average of 4.2 procedures. The length of the fibula used averaged 9.9 cm, and the fibula was fixed by intramedullary wires in 26 cases, and transfixion screws in 11 cases.
Results:
Follow-up averaged 8.1 years. Seventeen cases (43.6%) reached skeletal maturity before the final follow-up. Primary bone union was achieved in 37 cases (96%) after an average of 3.2 months. Stress fracture occurred in 21 cases (51.3%) and was recurrent in 11 cases. Twenty-one cases (53.8%) developed tibial shaft deformities with an average valgus angle of 13.8 degrees and procurvatum angle of 18.8 degrees. The overall final limb length discrepancy (LLD) averaged 2.2 cm. Ipsilateral ankle valgus deformity occurred in 21 cases (53.8%) and averaged 10 degrees. A total of 17 cases required an average of 2 secondary procedures. The tibial deformity did not appear to remodel with age, but the LLD and the angle of ipsilateral ankle valgus deformity continued to significantly increase until skeletal maturity.
Conclusion:
This study reports the largest single center experience of CPT cases treated with VFG. Free VFG is an excellent treatment option for CPT. Best results are achieved when the procedure is performed at or before the age of 3 years, in the absence of previous surgeries, and with the use of intramedullary fixation. The resulting LLD and the degree of ipsilateral ankle valgus increase with age until skeletal maturity, however, tibial deformity does not remodel and should be corrected at any age if it is excessive. Donor side mild ankle valgus may occur despite sound tibiofibular synostosis.
Level Of Evidence:
Level IV.
More Related Videos
10:31Surgical Angiogenesis in Porcine Tibial Allotransplantation: A New Large Animal Bone Vascularized Composite Allotransplantation Model
Published on: August 13, 2017
09:01Treatment of Ankle Osteoarthritis with Total Ankle Replacement Through a Lateral Transfibular Approach
Published on: January 24, 2018
