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Management of congenital pseudoarthrosis using Ilizarov Device-Delsuth, oghara experience
Roy E Enemudo1, Edwin O Edomwonyi2, Arthur T Obumse3
1Department of Orthopaedics and Trauma, Delta State University Teaching Hospital, Oghara, Delta State, Nigeria.
Insights
Congenital pseudoarthrosis of the tibia (CPT) is a challenging pediatric condition. A combination of Ilizarov procedure, bone graft, and bisphosphonate effectively treated CPT in five patients, achieving good to fair union outcomes.
Area of Science:
- Pediatric Orthopedics
- Regenerative Medicine
- Biomaterials Science
Background:
- Congenital pseudoarthrosis of the tibia (CPT) is a rare pediatric orthopedic condition characterized by spontaneous fracture or fracture from minor trauma.
- It arises from a dysplastic periosteum with increased osteoclastic and decreased osteoblastic activity.
- Effective management involves excising dysplastic periosteum, replacing it with viable tissue and bone graft, potentially with bone morphogenic proteins, and stabilizing with intramedullary implants.
Purpose of the Study:
- To evaluate the treatment outcomes of congenital pseudoarthrosis of the tibia (CPT) using the Ilizarov procedure, bone grafting, and bisphosphonate (sodium alendronate).
Main Methods:
- A retrospective study of five pediatric patients diagnosed with CPT was conducted.
- Patients were treated with the Ilizarov procedure, bone graft, and bisphosphonate at Delta State University Teaching Hospital, Nigeria.
- Inclusion criteria focused on spontaneous or minor trauma-induced tibial fractures, excluding pathological or significant trauma fractures.
Main Results:
- The study included five patients (2 males, 3 females) aged 6-18 years, with pre-operative limb length discrepancies of 6-12 cm.
- Four patients achieved good union, and one achieved fair union. Complications included ankle stiffness, regenerate bending, and loss of regenerate length.
- Two patients had hypertrophic CPT, and three had atrophic CPT.
Conclusions:
- Congenital pseudoarthrosis of the tibia (CPT) can be successfully managed using a combined approach involving the Ilizarov technique, bone grafting, bisphosphonates, and intramedullary nail support.
- This multimodal strategy addresses non-union and reduces the risk of post-operative refracture or non-union in CPT cases.
Background:
Congenital pseudoarthrosis of the tibia (CPT) is a rare and very difficult pediatric orthopedic condition to manage. It occurs spontaneously or from a trivial trauma. It results from a dysplastic periosteum that is more osteoclastic and less osteoblastic in nature. Successful treatment targets excision of the dysplastic periosteum and replacement with viable one and bone graft ± bone morphogenic proteins to aid union. Stabilization of the union site with intramedullary implants is advised to prevent refracture.
Aims:
To highlight the outcome of treatment of CPT with the Ilizarov procedure, bone graft, and use of bisphosphonate (sodium alendronate).
Patients And Methods:
This is a retrospective study of five patients treated for CPT using the Ilizarov procedure, bone graft, and use of bisphosphonate in the Delta State University Teaching Hospital, Oghara in Delta State, Nigeria. Inclusion criteria were patients that had a fracture of the tibia ± fibula spontaneously or from minor trauma. Exclusion criteria were patients that had pathological fractures or fractures from significant trauma. The outcome was graded into good, fair and poor.
Results:
Five patients were seen in this study. The male/female ratio was 2:3. The age was 6-18 years (mean = 11.5 years). The limb length discrepancy was 6-12 cm (mean = 7.2 cm) pre-operation and zero after completion of distraction. There was the loss of some regeneration in two patients at the end of consolidation. Two patients had hypertrophic CPT, while three patients had atrophic. Union was good in four and fair in one. Complications seen were ankle stiffness bending of the regenerate and loss of length of regenerate.
Conclusion:
CPT is a rare condition worldwide that is associated with non-union and complicated by post-operation refracture or non-union has been successfully treated with a procedure that entails use of Ilizarov technique, bone graft bisphosphonate and support with intramedullary nails.
