Congenital pseudarthrosis is a rare condition that can present in several forms. The
most common is the displasic fractured tibia presenting anterior and lateral angulations.
In general, there is an association with neurofibromatosis. Treatment consists of
resection of the diseased bone, interposition of a vascularized bone graft, and alignment
and correction of rotation and length of the lower leg.
The surgical technique is well–defined, since bone healing is best achieved by transplantation
of a vascularized fibular graft. Also, tibialization is rapid in the early ages. If
a stable fixation is easily attained in the peri–operative stage, it remains dificult
to maintain during the months that follow surgery, despite the use of KAFO. In fact,
the patients have been small children, economically poor, and with very restricted
social conditions. Taking care of this pediatric population is quite difficult; often
they are left alone and start walking by themselves without surveillance.
The series of congenital pseudarthrosis treated with vascularized fibular grafts has
reached 22 patients in the last 20 years. The ages of patients ranged from 11 months
to 9 years, with a mean of 4 years 9 months. Most of them (95.45%) were treated with
vascularized fibular grafts. Bone fixation was performed by external fixation in 3
cases, intramedulary nail in 12 cases, oblique K wires in 3 cases, and LCP plates
in 4 cases. Failure of the transplant occurred in 1 patient (4.55%). The incidence
of non union was 33% with external fixation, 58.33% with intramedullary nail, 66.5%
with oblique K wire, and 25% with LCP plate fixation. Final consolidation was obtained
in 90.9% of cases.
Although there is a controversy about the influence of bone fixation method over the
final results, the authors observed that the new LCP plate produces excelent results
in the osteopenic tibia lower third, when compared to other methods. The advantage
of screwing across the recepient bone and fixing directly to the plate as an internal
fixator allows early charging of the lower limb, dynamization of both ends, and rapid
consolidation and tibialization of the transplant.
