CONGENITAL PSEUDARTHROSIS

Follow-up Study after Massive Bone-Grafting

¹ Campbell Clinic, Memphis

1. In the seven cases reported, ten massive bone grafts have been used. Bony union followed all but one of these operations. This indicates that union can be anticipated in the majority of cases after this procedure. However, in three instances, refracture occurred following union.

2. In one patient, amputation was done after refracture. Bony union has been present following the second bone-graft operation for one and one-half years, two years, and three and one-half years, respectively. Union has persisted after the first massive graft for two and one-half, seven and one-half, and twenty-two years, respectively.

3. A refracture may be preceded by an increase in sclerosis about the fracture site, narrowing of a previously reformed medullary canal, or an insufficiency fracture. Routine follow-up roentgenograms should be made at six-month intervals to determine if any of these factors are developing, and, if so, surgical intervention may be indicated before a complete refracture occurs.

4. Following refracture, rapid absorption of the bone occurs, and the fracture site soon reverts to a condition simulating that seen in the original congenital pseudarthrosis.

5. It is probably unwise to draw conclusions as to end results in this condition until the patients have become young adults or at least are past puberty. In this series only Case 1 can be considered as having a good end result, according to these criteria.

6. At the termination of cast immobilization, adequate bracing must be maintained until a new medullary canal has developed and the consistency and size of the tibia compare favorably with the normal.

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