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.