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Late-onset pseudarthrosis of the dysplastic tibia
J W Roach1, R Shindell, N E Green
1Texas Scottish Rite Hospital, Dallas.
The Journal of Bone and Joint Surgery. American Volume
|November 1, 1993
Summary
Children with dysplastic tibia fractures often heal well after trauma, but some may develop deformities or require surgery. Late-onset pseudarthrosis in these cases may have a better prognosis than congenital cases.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Radiology
Background:
- Tibial fractures in children can occur after minor trauma.
- Pre-existing radiographic dysplastic changes in the tibia may predispose to fractures.
- These changes include cortical tapering, sclerosis, and medullary canal cysts.
Purpose of the Study:
- To investigate the outcomes of tibial fractures in children with pre-existing dysplastic changes.
- To compare the prognosis of late-onset pseudarthrosis with congenital pseudarthrosis.
Main Methods:
- Retrospective review of eleven children with tibial fractures and radiographic evidence of dysplasia.
- Analysis of fracture healing, long-term outcomes, and need for surgical intervention.
- Radiographic assessment of tibial alignment and cortical thickness.
Main Results:
- Ten of eleven patients had no further fractures at an average 15-year follow-up.
- Six fractures healed with casting, though four developed anterior bowing, suggesting future stress fracture risk.
- Four patients underwent corrective osteotomy, intramedullary fixation, and bone-grafting for improved alignment.
- One patient developed persistent pseudarthrosis despite multiple surgeries.
Conclusions:
- Tibial fractures in children with underlying dysplasia can heal, but may result in deformities.
- Surgical intervention can correct deformities and improve outcomes.
- Late-onset pseudarthrosis in dysplastic tibiae appears to have a more favorable prognosis than congenital pseudarthrosis.