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Use of an Intramedullary Rod for Treatment of Congenital Pseudarthrosis of the TibiaA Long-Term Follow-up Study
Matthew B. Dobbs, MD1; Margaret M. Rich, MD, PhD2; J. Eric Gordon, MD1; Deborah A. Szymanski, RN2; 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@msnotes.wustl.edu
2 St. Louis Shriners Hospital for Children, St. Louis, MO 63131
View Disclosures and Other Information
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.
Investigation performed at St. Louis Shriners Hospital for Children, St. Louis Children's Hospital, and Washington University School of Medicine, St. Louis, Missouri

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2004 Jun 01;86(6):1186-1197
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Abstract

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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    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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    Michael J Bell
    Posted on August 22, 2004
    Intramedullary Rod for Treatment of Congenital Pseudarthrosis of the Tibia
    NULL

    To the Editor:

    I read with interest the report of Dobbs and his colleagues regarding the use of an intramedullary rod for the treatment of congenital pseudarthrosis of the tibia. In their discussion they state that the intramedullary rod should extend into the hindfoot to stabilise the subtalar and ankle joint.

    In their list of references, they have not cited the article written by my group at the Sheffield Children’s Hospital in which we reported satisfactory results by using the Sheffield Intramedullary Nail System for this condition. This rod does not cross the ankle or subtalar joints. It is our view that it is not essential for the rod to cross both the ankle and subtalar joints (1).

    I would be grateful for the comments of Mr Dobbs and his colleagues and wonder why his literature review did not extend to papers published in your sister journal.

    1. Fern D Bell MJ. Expanding Rods in Congenital Pseudarthrosis of the Tibia. J Bone Joint Surg Br Nov 1990.

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