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
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
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.
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.