The Journal of Bone and Joint Surgery, Vol 74, Issue 2 169-178, Copyright © 1992 by Journal of Bone and Joint Surgery, Inc
Intramedullary fixation for congenital pseudarthrosis of the tibia
JK Baker, TE Cain and HS Tullos
Shriners Hospital for Crippled Children-Houston Unit, Texas 77030.
Eighteen consecutively seen patients who had a congenital pseudarthrosis of
the tibia were treated operatively. The mean age when the patients were
first seen was four years. Seventeen previous procedures had failed: six
patients had had one previous procedure; three, two previous procedures;
and one, five previous procedures. At an average follow-up interval of ten
years (range, three to nineteen years), healing with re-formation of the
medullary canal was seen in thirteen of the eighteen tibiae, including one
tibia that had united after a Boyd amputation. Five patients did not have
healing of the tibia: four of them had a below-the-knee amputation, and one
declined additional treatment. The average residual angulation was 12
degrees in the sagittal plane and 5 degrees in the coronal plane. Union
occurred in ten of the thirteen patients who had been managed with
intramedullary fixation. Of these thirteen, eight had been managed with
intramedullary fixation, bone-grafting, and implantation of an electrical
stimulator, and seven of them had union. Five of the thirteen patients had
been managed with intramedullary fixation and bone-grafting, and three of
them had union. Union occurred in one of two patients who had been managed
with vascularized free fibular transfer, one who had been managed with
delayed bone-grafting, and one who had been managed with a Boyd amputation.
Four of the five patients who did not have union were subsequently managed
with a below-the-knee amputation, and one patient refused additional
treatment.
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