Management of Congenital Pseudoarthrosis using Ilizarov Device– Delsuth, Oghara Experience

Abstract

Background: Congenital pseudoarthrosis of the tibia (CPT) is a rare and very difficult pediatric orthopedic condition to manage. It occurs spontaneously or from a trivial trauma. It results from a dysplastic periosteum that is more osteoclastic and less osteoblastic in nature. Successful treatment targets excision of the dysplastic periosteum and replacement with viable one and bone graft ± bone morphogenic proteins to aid union. Stabilization of the  union site with intramedullary implants is advised to prevent refracture.

Aims: To highlight the outcome of treatment of CPT with the Ilizarov procedure,  bone graft, and use of bisphosphonate (sodium alendronate).

Patients and Methods: This is a retrospective study of five patients treated for CPT using  the Ilizarov procedure, bone graft, and use of bisphosphonate  in the Delta State University Teaching Hospital, Oghara in Delta State, Nigeria. Inclusion criteria were patients that had a fracture of the tibia ± fibula  spontaneously or from minor trauma. Exclusion criteria were patients that had pathological fractures or fractures from significant trauma. The outcome  was graded into good, fair and poor.

Results: Five patients were seen in this study. The male/female ratio was 2:3. The age was 6–18 years (mean = 11.5  years). The limb length discrepancy was 6–12 cm (mean = 7.2 cm) pre-operation and zero after completion of distraction. There was the loss of some  regeneration in two patients at the end of consolidation. Two patients had hypertrophic CPT, while three patients had atrophic. Union was good in four  and fair in one. Complications seen were ankle stiffness bending of the regenerate and loss of length of regenerate.

Conclusion: CPT is a rare condition  worldwide that is associated with nonunion and complicated by post-operation refracture or non-union has been successfully treated with a procedure  that entails use of Ilizarov technique, bone graft bisphosphonate and support with intramedullary nails.