Surgical and electrical methods in the treatment of congenital and posttraumatic pseudarthrosis of the tibia

This is a report of two adult patients with posttraumatic and seven children with congenital pseudarthroses treated by surgical and electrical methods. Interest was focused primarily on congenital pseudarthroses because of the unquestionable severity of these cases and consequently a very high benefit/risk ratio. Three procedures were used: external (Hoffmann) fixation combined with monophasic or biphasic pulsed current stimulation; internal (transtarsal) fixation combined with pulsed electromagnetic field stimulation; and surgical treatment only, as above, without electrostimulation. Healing was achieved in both treated cases of posttraumatic pseudarthrosis and in nine of 14 instances in cases of congenital pseudarthrosis stimulated electrically, as well as in two instances with no electrostimulation. In seven instances, the bone remained healed for nine months or more, the longest period being almost 5.5 years. Both pulsed current and electromagnetic field stimulation seem to enhance the process of bone healing. However, comparison between the different stimulation methods cannot be made on the basis of the limited material presented here, and the need for more basic studies still exists. Concerning the surgical treatment, it seems that transtarsal fixation is a better choice for congenital pseudarthrosis than fixation with an AO-plate, Rush pin or Hoffmann apparatus.