Reconstruction of congenital tibial pseudarthrosis by revascularized fibular transplants

Seven patients with congenital Boyd type II pseudoarthrosis of the tibia and fibula were treated with a revascularized osteocutaneous fibular graft from the contralateral side. Follow-up ranged from 20 to 96 months (mean 67 months). All patients had previously undergone major surgery (mean three operations). Union was successful in all patients although three required further surgery. At follow-up all patients were able to walk without external support. The results were classified as good in two cases and fair in five cases. The postoperative period was, however, often complicated by stress-fracture and nonunion. Leg length discrepancy and valgus deformity are still unsolved problems in some cases. It seems probable that a primary reconstruction at an early age will prevent many of these subsequent problems.