Comparison of two different intramedullary rods combined with Ilizarov external fixation and wrapped autologous iliac bone grafting for the treatment of congenital tibial pseudarthrosis in children

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Objective: To compare the initial clinical efficacy of extensible intramedullary rod fixation and Williams intramedullary rod fixation combined with Ilizarov external fixation and wrapped autologous iliac bone grafting in the treatment of congenital tibial pseudarthrosis in children. Methods: A retrospective analysis was conducted on the clinical data of 60 children with Crawford Ⅳtype congenital pseudarthrosis of the tibia treated with combined surgery at the Orthopedics Department of Hunan Children's Hospital from January 2013 to December 2020.According to different internal fixation methods,patients were divided into the extensible intramedullary rod group (30 cases) and the Williams intramedullary rod group (30 cases). There were 12 males and 18 females in the extendable intramedullary rod group, aged (33.6±6.3) months (range: 18 to 44 months), while there were 10 males and 20 females in the Williams intramedullary rod group, aged (47.8±8.6) months (range: 36 to 66 months). The anteroposterior and lateral views of tibia and fibula and the full length anteroposterior film of both lower limbs were examined to compare the clinical treatment effects of the two groups at 1-,3-,6-,9-, and 12-month after surgery. Independent sample t-test, χ2 test or Fisher exact test was used for inter group comparison. Results: Both groups of children underwent surgery successfully, with postoperative follow-up time greater than 2 years. The extensible intramedullary rod group was followed up for (49.5±6.4) months, while the Williams intramedullary rod group was followed up for (53.7±10.5) months. The initial bone healing time between the broken ends of the tibial pseudarthrosis was (5.1±0.8) months in the extensible intramedullary rod group and (5.0±0.6) months in the Williams intramedullary rod group. There was no statistically significant difference between the two groups (t=0.584, P=0.562). The initial postoperative bone healing rate of the extensible intramedullary rod group was 93.3% (28/30), while that of the Williams intramedullary rod group was 96.7% (29/30). There was no statistically significant difference between the groups (χ2=0.351 P=0.554).The postoperative fracture rate of the extensible intramedullary rod group was 20.0% (6/30), while that of the Williams intramedullary rod group was 16.7% (5/30);Six cases (20.0%) in the extensible intramedullary rod group had unequal limb lengths in both lower limbs after surgery, with a limb length difference of (2.5±1.4)cm (range: 1.5 to 5.2 cm). Eight cases (26.7%) in the Williams intramedullary rod group had a limb length difference of (2.8±1.4)cm (range: 1.8 to 6.0 cm);After surgery, there were 4 (13.3%) cases of proximal tibial valgus deformity in the extensible intramedullary rod group, with an valgus angle range of (12.5±4.9)° (range: 7 °to 18°), and 3 (10.0%) cases in the Williams intramedullary rod group, with an valgus angle of (15.0±6.0)° (range: 9°to 21°). There were 2 (6.7%) cases of ankle valgus deformity in the extensible intramedullary rod group, with an valgus angle of (11.5±4.9)° (range: 8 °to 15°), and 4 (13.3%) cases in the Williams intramedullary rod group, with an valgus angle of (14.8±6.2)° (range: 6 °to 20°). The postoperative activities of the knee and ankle joints in the extensible intramedullary rod group were normal and unrestricted, with 4 cases of extensible intramedullary rod displacement.In the Williams intramedullary rod group, there were 30 cases of postoperative ankle joint stiffness and no displacement of the fixation position of the intramedullary rod.There was no statistically significant difference in postoperative complications between the two groups of children (all P>0.05). Conclusions: The use of both extensible intramedullary rods and Williams intramedullary rods in the combined surgery for congenital tibial pseudarthrosis in children can achieve effective internal fixation results. The initial postoperative bone healing rate is high, and there is no difference in the incidence of postoperative complications between groups. Both internal fixation methods have their own advantages and disadvantages, and suitable internal fixation methods can be selected based on the characteristics of the patient.