Treatment of congenital and infantile pseudarthrosis of the tibia with pulsing electromagnetic fields

The management of congenital and infantile pseudarthrosis of the tibia poses difficult problems because of the variability in the type and prognosis of the lesion and varied response to surgical treatment. Whatever the severity of the lesion, the use of pulsed electromagnetic fields can be expected to improve the prognosis for union by a factor of at least 20 per cent. In a very few patients, usually those with pseudarthrosis presenting later in life, pulsed electromagnetic fields alone together with plaster immobilization may be sufficient to produce union. In some, partially successful previous surgery may be made completely successful by subsequent application of pulsed electromagnetic fields. In patients with a fair or good prognosis as regards the type of lesion, a combination of surgery and pulsed electromagnetic treatment, some period of which may also be given before surgical treatment, gives a moderately high rate of success. In the three groups already described, the overall success rate is likely to be more than 70 per cent. In lesions with a poor prognosis, or after multiple surgical procedures in an older child, a combination of very adequate further surgery and pulsed electromagnetic fields can produce union in perhaps 30 per cent of cases, but it is unwise to commence any treatment if the limb is already unacceptably short, if there is gross wasting of the limb with evidence of inadequate vascular supply, and/or if the joints of the foot and ankle are stiff and associated with deformity. In such cases, the procedure of choice is amputation.