Reconstructive Approaches in Surgical Management of Congenital Pseudarthrosis of the Tibia
Treatment of congenital pseudarthrosis of the tibia remains a major challenge in pediatric orthopedics. Ideal timing and preference of surgical procedures are discussed controversially. A variety of reconstructive treatment strategies have been described in literature, but so far none has proven its...
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| Format: | Article |
| Language: | English |
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MDPI AG
2020-12-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/9/12/4132 |
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| author | Andrea Laufer Adrien Frommer Georg Gosheger Robert Roedl Frank Schiedel Jan Niklas Broeking Gregor Toporowski Anna Rachbauer Carina Antfang Bjoern Vogt |
| author_facet | Andrea Laufer Adrien Frommer Georg Gosheger Robert Roedl Frank Schiedel Jan Niklas Broeking Gregor Toporowski Anna Rachbauer Carina Antfang Bjoern Vogt |
| author_sort | Andrea Laufer |
| collection | DOAJ |
| description | Treatment of congenital pseudarthrosis of the tibia remains a major challenge in pediatric orthopedics. Ideal timing and preference of surgical procedures are discussed controversially. A variety of reconstructive treatment strategies have been described in literature, but so far none has proven its superiority. The aim of treatment is to obtain long-term bone union, to prevent refracture, and to correct angular deformities and leg length discrepancies. This study retrospectively evaluates the outcome of different reconstructive strategies. Sixty-nine patients were identified who presented to our outpatient department between 1997 and 2019. Twenty-six of these patients underwent reconstructive surgical treatment and were included in this study. The study cohort was divided into three groups. Excision of the pseudarthrosis was performed in all patients in Group A and B, and in two patients of Group C. Group A (six/26 patients) received subsequent bone transport through external fixation maintaining original length. In Group B (15/26 patients), patients underwent either previous, simultaneous, or subsequent extrafocal lengthening through external fixation to reconstitute length. In Group C (five/26 patients), internal fixation with intramedullary nails was applied. Radiological and clinical evaluation was performed to assess bone union and complication rates. Results varied considerably between the study groups. Overall, the primary bone fusion rate was 69.2%. There were four refractures, all occurring in Group B. The long-term bone union rate without refracture was 53.8%. The overall complication rate was 53.8% and 23.1% showed persistent pseudarthrosis. Two secondary amputations were performed due to failed bone fusion. In conclusion, excision of the pseudarthrosis and extrafocal lengthening achieves a satisfying bone union rate and limb reconstruction, while bone transport does not offer significant advantages but shows higher complication rates. Intramedullary stabilization should be applied to maintain bone union, but shows lower bone union rates when used as a stand-alone treatment regimen. Regardless of the primary bone fusion rates, the probability of long-term bone union remains unpredictable. |
| first_indexed | 2024-03-10T13:52:36Z |
| format | Article |
| id | doaj.art-b3944103595d492e8b35011b910cd4af |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T13:52:36Z |
| publishDate | 2020-12-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-b3944103595d492e8b35011b910cd4af2023-11-21T01:58:32ZengMDPI AGJournal of Clinical Medicine2077-03832020-12-01912413210.3390/jcm9124132Reconstructive Approaches in Surgical Management of Congenital Pseudarthrosis of the TibiaAndrea Laufer0Adrien Frommer1Georg Gosheger2Robert Roedl3Frank Schiedel4Jan Niklas Broeking5Gregor Toporowski6Anna Rachbauer7Carina Antfang8Bjoern Vogt9Pediatric Orthopedics, Deformity Reconstruction and Foot Surgery, University Hospital Muenster, 48149 Muenster, GermanyPediatric Orthopedics, Deformity Reconstruction and Foot Surgery, University Hospital Muenster, 48149 Muenster, GermanyGeneral Orthopedics and Tumor Orthopedics, University Hospital Muenster, 48149 Muenster, GermanyPediatric Orthopedics, Deformity Reconstruction and Foot Surgery, University Hospital Muenster, 48149 Muenster, GermanyPediatric Orthopedics and Deformity Reconstruction, Clemens Hospital Muenster, 48153 Muenster, GermanyPediatric Orthopedics, Deformity Reconstruction and Foot Surgery, University Hospital Muenster, 48149 Muenster, GermanyPediatric Orthopedics, Deformity Reconstruction and Foot Surgery, University Hospital Muenster, 48149 Muenster, GermanyPediatric Orthopedics, Deformity Reconstruction and Foot Surgery, University Hospital Muenster, 48149 Muenster, GermanyPediatric Orthopedics, Deformity Reconstruction and Foot Surgery, University Hospital Muenster, 48149 Muenster, GermanyPediatric Orthopedics, Deformity Reconstruction and Foot Surgery, University Hospital Muenster, 48149 Muenster, GermanyTreatment of congenital pseudarthrosis of the tibia remains a major challenge in pediatric orthopedics. Ideal timing and preference of surgical procedures are discussed controversially. A variety of reconstructive treatment strategies have been described in literature, but so far none has proven its superiority. The aim of treatment is to obtain long-term bone union, to prevent refracture, and to correct angular deformities and leg length discrepancies. This study retrospectively evaluates the outcome of different reconstructive strategies. Sixty-nine patients were identified who presented to our outpatient department between 1997 and 2019. Twenty-six of these patients underwent reconstructive surgical treatment and were included in this study. The study cohort was divided into three groups. Excision of the pseudarthrosis was performed in all patients in Group A and B, and in two patients of Group C. Group A (six/26 patients) received subsequent bone transport through external fixation maintaining original length. In Group B (15/26 patients), patients underwent either previous, simultaneous, or subsequent extrafocal lengthening through external fixation to reconstitute length. In Group C (five/26 patients), internal fixation with intramedullary nails was applied. Radiological and clinical evaluation was performed to assess bone union and complication rates. Results varied considerably between the study groups. Overall, the primary bone fusion rate was 69.2%. There were four refractures, all occurring in Group B. The long-term bone union rate without refracture was 53.8%. The overall complication rate was 53.8% and 23.1% showed persistent pseudarthrosis. Two secondary amputations were performed due to failed bone fusion. In conclusion, excision of the pseudarthrosis and extrafocal lengthening achieves a satisfying bone union rate and limb reconstruction, while bone transport does not offer significant advantages but shows higher complication rates. Intramedullary stabilization should be applied to maintain bone union, but shows lower bone union rates when used as a stand-alone treatment regimen. Regardless of the primary bone fusion rates, the probability of long-term bone union remains unpredictable.https://www.mdpi.com/2077-0383/9/12/4132congenital pseudarthrosis of the tibiabone transportdistraction osteogenesisexternal fixatorintramedullary nail |
| spellingShingle | Andrea Laufer Adrien Frommer Georg Gosheger Robert Roedl Frank Schiedel Jan Niklas Broeking Gregor Toporowski Anna Rachbauer Carina Antfang Bjoern Vogt Reconstructive Approaches in Surgical Management of Congenital Pseudarthrosis of the Tibia Journal of Clinical Medicine congenital pseudarthrosis of the tibia bone transport distraction osteogenesis external fixator intramedullary nail |
| title | Reconstructive Approaches in Surgical Management of Congenital Pseudarthrosis of the Tibia |
| title_full | Reconstructive Approaches in Surgical Management of Congenital Pseudarthrosis of the Tibia |
| title_fullStr | Reconstructive Approaches in Surgical Management of Congenital Pseudarthrosis of the Tibia |
| title_full_unstemmed | Reconstructive Approaches in Surgical Management of Congenital Pseudarthrosis of the Tibia |
| title_short | Reconstructive Approaches in Surgical Management of Congenital Pseudarthrosis of the Tibia |
| title_sort | reconstructive approaches in surgical management of congenital pseudarthrosis of the tibia |
| topic | congenital pseudarthrosis of the tibia bone transport distraction osteogenesis external fixator intramedullary nail |
| url | https://www.mdpi.com/2077-0383/9/12/4132 |
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