The Journal of Bone and Joint Surgery, Vol 74, Issue 2 161-168, Copyright © 1992 by Journal of Bone and Joint Surgery, Inc
Use of an intramedullary rod for the treatment of congenital pseudarthrosis of the tibia
DJ Anderson, PL Schoenecker, JJ Sheridan and MM Rich
Shriners Hospitals for Crippled Children, St. Louis Unit, Missouri 63131.
The use of an intramedullary rod as described by Williams, combined with
implantation of an autogenous bone graft, resulted in union of an
established congenital pseudarthrosis of the tibia in nine of ten patients.
One patient needed additional bone-grafting before union occurred. The
average age at the time of the operation was five years and three months. A
rod of the appropriate length was inserted at the site of the non-union,
antegrade through the distal part of the tibia and the hindfoot and then
retrograde through the proximal fragment. This resulted in splinting of the
tibia, ankle, and subtalar joints. Solid osseous union occurred an average
of six months after the procedure in all ten patients. Five patients had a
refracture of the tibia after the initial consolidation. Three of the five
needed one or more additional operative procedures; one was managed with a
cast; and one patient, who had been followed for four years before the
refracture, did not return for treatment of the refracture. As is the plan
with this method of treatment, the distal part of the tibia grew off the
rod and the distal tip of the rod was located proximal to the foot and
ankle, or it was located more proximally than it had been at the operation,
in six patients. The rod was removed from three patients. At an average of
six years, all ten patients were able to walk without pain.
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