Treatment of Refractory Congenital Pseudoarthrosis of Tibia with Contralateral Vascularized Fibular Bone Graft and Anatomic Distal Tibial Locking Plate: A Case Series and Literature Review
Background: Congenital pseudoarthrosis of the tibia (CPT) remains a challenge for physicians. Several treatment options have been proposed, but the standard of care remains inconclusive. In this study, we present three patients for whom the failure of prior treatments was managed with a contralatera...
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-03-01
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| Series: | Children |
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| Online Access: | https://www.mdpi.com/2227-9067/10/3/503 |
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| author | Te-Feng Arthur Chou Ting-Yu Liu Matthew N. Wang Chen-Yuan Yang |
| author_facet | Te-Feng Arthur Chou Ting-Yu Liu Matthew N. Wang Chen-Yuan Yang |
| author_sort | Te-Feng Arthur Chou |
| collection | DOAJ |
| description | Background: Congenital pseudoarthrosis of the tibia (CPT) remains a challenge for physicians. Several treatment options have been proposed, but the standard of care remains inconclusive. In this study, we present three patients for whom the failure of prior treatments was managed with a contralateral vascularized fibular bone graft (VFG) and an anatomic distal tibial locking plate. Methods: Between 2017 and 2021, three patients were referred for failed treatment of CPT. All patients had undergone multiple prior surgeries, including tumor excision and fixation with ring external fixators, plates, and screws. We performed radical tumor resection and reconstruction of bone defects with a VFG. The construct was fixed with an anatomic locking plate, and the patients were followed up for a mean of 45.7 months. Results: All three patients were able to obtain graft union at 19.3 weeks. At the final follow-up, all grafts achieved bony hypertrophy without evidence of bone resorption or local tumor recurrence. There was a mean leg length difference of 8.5 cm preoperatively, compared with 6.3 cm postoperatively. The average lower leg angulation was 7.4 degrees and the average ankle range of motion was 58.3 degrees. The mean VAS score was 0 and the mean AOFAS score was 88.3. No significant complications were noted. Conclusions: Implantation of a VFG and an anatomic distal tibia locking plate can be considered an option for treatment-refractory CPT. Patients can expect to achieve bone consolidation, ambulate as tolerated, and have a low complication rate. |
| first_indexed | 2024-03-11T06:44:36Z |
| format | Article |
| id | doaj.art-31d0c94255d14a9aa5c759b007b14ea0 |
| institution | Directory Open Access Journal |
| issn | 2227-9067 |
| language | English |
| last_indexed | 2024-03-11T06:44:36Z |
| publishDate | 2023-03-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Children |
| spelling | doaj.art-31d0c94255d14a9aa5c759b007b14ea02023-11-17T10:21:11ZengMDPI AGChildren2227-90672023-03-0110350310.3390/children10030503Treatment of Refractory Congenital Pseudoarthrosis of Tibia with Contralateral Vascularized Fibular Bone Graft and Anatomic Distal Tibial Locking Plate: A Case Series and Literature ReviewTe-Feng Arthur Chou0Ting-Yu Liu1Matthew N. Wang2Chen-Yuan Yang3Department of Orthopaedics, Kuang Tien General Hospital, Taichung 433401, TaiwanDepartment of Orthopaedics, Kuang Tien General Hospital, Taichung 433401, TaiwanDepartment of Orthopaedics, Kuang Tien General Hospital, Taichung 433401, TaiwanDepartment of Orthopaedics, Kuang Tien General Hospital, Taichung 433401, TaiwanBackground: Congenital pseudoarthrosis of the tibia (CPT) remains a challenge for physicians. Several treatment options have been proposed, but the standard of care remains inconclusive. In this study, we present three patients for whom the failure of prior treatments was managed with a contralateral vascularized fibular bone graft (VFG) and an anatomic distal tibial locking plate. Methods: Between 2017 and 2021, three patients were referred for failed treatment of CPT. All patients had undergone multiple prior surgeries, including tumor excision and fixation with ring external fixators, plates, and screws. We performed radical tumor resection and reconstruction of bone defects with a VFG. The construct was fixed with an anatomic locking plate, and the patients were followed up for a mean of 45.7 months. Results: All three patients were able to obtain graft union at 19.3 weeks. At the final follow-up, all grafts achieved bony hypertrophy without evidence of bone resorption or local tumor recurrence. There was a mean leg length difference of 8.5 cm preoperatively, compared with 6.3 cm postoperatively. The average lower leg angulation was 7.4 degrees and the average ankle range of motion was 58.3 degrees. The mean VAS score was 0 and the mean AOFAS score was 88.3. No significant complications were noted. Conclusions: Implantation of a VFG and an anatomic distal tibia locking plate can be considered an option for treatment-refractory CPT. Patients can expect to achieve bone consolidation, ambulate as tolerated, and have a low complication rate.https://www.mdpi.com/2227-9067/10/3/503congenital pseudoarthrosis of tibiaautologous vascularized bone graftfree-fibular bone grafttibial nonunionneurofibromatosisanatomic distal tibia locking plate |
| spellingShingle | Te-Feng Arthur Chou Ting-Yu Liu Matthew N. Wang Chen-Yuan Yang Treatment of Refractory Congenital Pseudoarthrosis of Tibia with Contralateral Vascularized Fibular Bone Graft and Anatomic Distal Tibial Locking Plate: A Case Series and Literature Review Children congenital pseudoarthrosis of tibia autologous vascularized bone graft free-fibular bone graft tibial nonunion neurofibromatosis anatomic distal tibia locking plate |
| title | Treatment of Refractory Congenital Pseudoarthrosis of Tibia with Contralateral Vascularized Fibular Bone Graft and Anatomic Distal Tibial Locking Plate: A Case Series and Literature Review |
| title_full | Treatment of Refractory Congenital Pseudoarthrosis of Tibia with Contralateral Vascularized Fibular Bone Graft and Anatomic Distal Tibial Locking Plate: A Case Series and Literature Review |
| title_fullStr | Treatment of Refractory Congenital Pseudoarthrosis of Tibia with Contralateral Vascularized Fibular Bone Graft and Anatomic Distal Tibial Locking Plate: A Case Series and Literature Review |
| title_full_unstemmed | Treatment of Refractory Congenital Pseudoarthrosis of Tibia with Contralateral Vascularized Fibular Bone Graft and Anatomic Distal Tibial Locking Plate: A Case Series and Literature Review |
| title_short | Treatment of Refractory Congenital Pseudoarthrosis of Tibia with Contralateral Vascularized Fibular Bone Graft and Anatomic Distal Tibial Locking Plate: A Case Series and Literature Review |
| title_sort | treatment of refractory congenital pseudoarthrosis of tibia with contralateral vascularized fibular bone graft and anatomic distal tibial locking plate a case series and literature review |
| topic | congenital pseudoarthrosis of tibia autologous vascularized bone graft free-fibular bone graft tibial nonunion neurofibromatosis anatomic distal tibia locking plate |
| url | https://www.mdpi.com/2227-9067/10/3/503 |
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