Congenital pseudoarthrosis of the tibia: role of the fibula

Abstract

Objective Congenital pseudoarthrosis of the tibia is still a mystery and a great challenge to pediatric orthopedic surgeon. Owing to the different morphology of congenital pseudoarthrosis of the tibia, there are many treatment options with many debatable points. The fibula is a main strut that protects the tibial union and has implications on the orientation of the ankle. Patients and methods Nine patients had congenital pesudoarthrosis of the tibia, and their average age at the time of operation was 3.8 years; four of these nine patients had intact fibula (group 1), whereas five had associated pseudoarthrosis of the fibula (group 2). The treatment method was decided depending on the condition of the fibula, whether it was intact or affected by pseudoarthrosis. In cases with intact fibula, tibiofibular fusion was done. However, in cases with associated fibular pseudoarthrosis, the pathologic pseudoarthrotic tissues were resected and the tibia and fibula were fixed with intramedullary wires and Ilizarov ring fixator. Results A union rate of 100% was achieved without a refracture till the last follow-up. Good tibial alignment was achieved in all cases, and wide cross-sectional area at the pseudoarthrosis site was obtained in all cases. One case with fibula plus +1 position was complicated with a varus deformity of the ankle. Conclusion Addressing the fibular problem safeguards against refracture and protects against ankle joint deformity. Achieving tibial union with wide regenerate or wide fusion mass, good tibial alignment and fibular union is mandatory for preventing refracture. The article was level of evidence IV.