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The Journal of Bone and Joint Surgery (American) 86:1186-1197 (2004)
© 2004 The Journal of Bone and Joint Surgery, Inc.

Use of an Intramedullary Rod for Treatment of Congenital Pseudarthrosis of the Tibia

A Long-Term Follow-up Study

Matthew B. Dobbs, MD1, Margaret M. Rich, MD, PhD2, J. Eric Gordon, MD1, Deborah A. Szymanski, RN2 and Perry L. Schoenecker, MD1

1 Department of Orthopaedic Surgery, Washington University School of Medicine, One Children's Place, Suite 4S20, St. Louis, MO 63110. E-mail address for P.L. Schoenecker: schoeneckerp{at}msnotes.wustl.edu
2 St. Louis Shriners Hospital for Children, St. Louis, MO 63131

Investigation performed at St. Louis Shriners Hospital for Children, St. Louis Children's Hospital, and Washington University School of Medicine, St. Louis, Missouri

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

A video supplement to this article is available from the Video Jour- nal of Orthopaedics. A video clip is available at the JBJS web site, www.jbjs.org. The Video Journal of Orthopaedics can be contacted at (805) 962-3410, web site: www.vjortho.com.

Background: The treatment of congenital pseudarthrosis of the tibia remains difficult and controversial. The purpose of this study was to evaluate the long-term results of a technique consisting of excision of the pseudarthrosis, autologous bone-grafting, and insertion of a Williams intramedullary rod into the tibia.

Methods: Twenty-one consecutive patients with congenital pseudarthrosis of the tibia were managed with this technique between 1978 and 1999, and the results were retrospectively reviewed. The mean age of the patients at the time of the latest follow-up was 17.2 years (range, seven to twenty-five years), and the mean duration of postoperative follow-up was 14.2 years (range, three to twenty years).

Results: Initial consolidation occurred in eighteen of the twenty-one patients. Refracture occurred in twelve patients; five fractures healed with closed treatment, five healed after an additional surgical procedure, and two ultimately required amputation. Ten patients had an ankle valgus deformity after tibial union. Eleven patients had a residual limb-length discrepancy of >2 cm; six required a contralateral distal femoral and/or proximal tibial epiphyseodesis, two had a tibial lengthening, and one used a shoe-lift. Five patients had an amputation: two, because of a recalcitrant fracture; two, because of a limb-length discrepancy (6 and 9 cm); and one, because of a chronic lower-extremity deformity.

Conclusions: This technique produced a satisfactory long-term functional outcome in sixteen of twenty-one patients and should be considered for the management of congenital pseudarthrosis of the tibia.

Level of Evidence: Therapeutic study, Level IV (case series [no, or historical, control group]). See Instructions to Authors for a complete description of levels of evidence.


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This article has been cited by other articles:


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K. L. Vander Have, R. N. Hensinger, M. Caird, C. Johnston, and F. A. Farley
Congenital Pseudarthrosis of the Tibia
J. Am. Acad. Ortho. Surg., April 1, 2008; 16(4): 228 - 236.
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F. Y.-I. Lee, S. M. Sinicropi, F. S. Lee, M. G. Vitale, D. P. Roye Jr., and I. H. Choi
Treatment of Congenital Pseudarthrosis of the Tibia with Recombinant Human Bone Morphogenetic Protein-7 (rhBMP-7) A Report of Five Cases
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Letters to the Editor:

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Intramedullary Rod for Treatment of Congenital Pseudarthrosis of the Tibia
Michael J Bell
JBJS Online, 23 Aug 2004 [Full text]