Cross-Union Surgery for Congenital Pseudarthrosis of the Tibia
Congenital Pseudoarthrosis of the Tibia (CPT) is a rare condition with a reputation for recurrent fractures and failure to achieve union. A large variety of surgical procedures have been attempted for the treatment of fractured cases of CPT with an average rate of union without refracture of only 50...
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| Format: | Article |
| Language: | English |
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MDPI AG
2021-06-01
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| Series: | Children |
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| Online Access: | https://www.mdpi.com/2227-9067/8/7/547 |
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| author | Claire E. Shannon Aaron J. Huser Dror Paley |
| author_facet | Claire E. Shannon Aaron J. Huser Dror Paley |
| author_sort | Claire E. Shannon |
| collection | DOAJ |
| description | Congenital Pseudoarthrosis of the Tibia (CPT) is a rare condition with a reputation for recurrent fractures and failure to achieve union. A large variety of surgical procedures have been attempted for the treatment of fractured cases of CPT with an average rate of union without refracture of only 50%. Intentional cross-union between the tibia and fibula has been reported to improve these results to 100% union with no refractures. This is a retrospective study of 39 cases of CPT in 36 patients treated by the Paley cross-union protocol with internal fixation, bone grafting, zoledronic acid infusion and bone morphogenic protein 2 (BMP2) insertion. All 39 cases of CPT united at the tibia and developed a cross-union to the fibula. Two patients had a persistent fibular pseudarthrosis, one that was later treated at the time of planned rod exchange and one that has remained asymptomatic. There were few postoperative complications. There were no refractures during the up to 7-year follow-up period. The most common problem was the Fassier-Duval (FD) rod pulling through the proximal or distal physis into the metaphysis (66.7%). This did not negatively affect the results and was remedied at the time of the planned rod exchange. The Paley Cross-Union Protocol is very technically demanding, but the results have radically changed the prognosis of this once sinister disease. |
| first_indexed | 2024-03-10T10:04:12Z |
| format | Article |
| id | doaj.art-0ab4387b938d42078efc348a379fc502 |
| institution | Directory Open Access Journal |
| issn | 2227-9067 |
| language | English |
| last_indexed | 2024-03-10T10:04:12Z |
| publishDate | 2021-06-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Children |
| spelling | doaj.art-0ab4387b938d42078efc348a379fc5022023-11-22T01:39:34ZengMDPI AGChildren2227-90672021-06-018754710.3390/children8070547Cross-Union Surgery for Congenital Pseudarthrosis of the TibiaClaire E. Shannon0Aaron J. Huser1Dror Paley2Paley Orthopedic and Spine Institute, West Palm Beach, FL 33407, USAPaley Orthopedic and Spine Institute, West Palm Beach, FL 33407, USAPaley Orthopedic and Spine Institute, West Palm Beach, FL 33407, USACongenital Pseudoarthrosis of the Tibia (CPT) is a rare condition with a reputation for recurrent fractures and failure to achieve union. A large variety of surgical procedures have been attempted for the treatment of fractured cases of CPT with an average rate of union without refracture of only 50%. Intentional cross-union between the tibia and fibula has been reported to improve these results to 100% union with no refractures. This is a retrospective study of 39 cases of CPT in 36 patients treated by the Paley cross-union protocol with internal fixation, bone grafting, zoledronic acid infusion and bone morphogenic protein 2 (BMP2) insertion. All 39 cases of CPT united at the tibia and developed a cross-union to the fibula. Two patients had a persistent fibular pseudarthrosis, one that was later treated at the time of planned rod exchange and one that has remained asymptomatic. There were few postoperative complications. There were no refractures during the up to 7-year follow-up period. The most common problem was the Fassier-Duval (FD) rod pulling through the proximal or distal physis into the metaphysis (66.7%). This did not negatively affect the results and was remedied at the time of the planned rod exchange. The Paley Cross-Union Protocol is very technically demanding, but the results have radically changed the prognosis of this once sinister disease.https://www.mdpi.com/2227-9067/8/7/547congenital pseudarthrosis of the tibia (CPT)congenital pseudarthrosis of the fibulaneurofibromatosis 1NF1cross-unionanterolateral bowing |
| spellingShingle | Claire E. Shannon Aaron J. Huser Dror Paley Cross-Union Surgery for Congenital Pseudarthrosis of the Tibia Children congenital pseudarthrosis of the tibia (CPT) congenital pseudarthrosis of the fibula neurofibromatosis 1 NF1 cross-union anterolateral bowing |
| title | Cross-Union Surgery for Congenital Pseudarthrosis of the Tibia |
| title_full | Cross-Union Surgery for Congenital Pseudarthrosis of the Tibia |
| title_fullStr | Cross-Union Surgery for Congenital Pseudarthrosis of the Tibia |
| title_full_unstemmed | Cross-Union Surgery for Congenital Pseudarthrosis of the Tibia |
| title_short | Cross-Union Surgery for Congenital Pseudarthrosis of the Tibia |
| title_sort | cross union surgery for congenital pseudarthrosis of the tibia |
| topic | congenital pseudarthrosis of the tibia (CPT) congenital pseudarthrosis of the fibula neurofibromatosis 1 NF1 cross-union anterolateral bowing |
| url | https://www.mdpi.com/2227-9067/8/7/547 |
| work_keys_str_mv | AT claireeshannon crossunionsurgeryforcongenitalpseudarthrosisofthetibia AT aaronjhuser crossunionsurgeryforcongenitalpseudarthrosisofthetibia AT drorpaley crossunionsurgeryforcongenitalpseudarthrosisofthetibia |