Abstract
BackgroundThe purpose of our retrospective study was to evaluate the preliminary result of distraction osteogenesis in patient with tibial shortening after initial union of Congenital Pseudarthrosis of the Tibia (CPT).MethodsAll the CPT cases with tibial shortening after initial union managed by proximal tibial lengthening using Ilizarov technique were identified. All the patient charts and radiograms were reviewed.ResultsBetween March 2007 and January 2012, 11 CPT cases were included with an average follow-up of 41 months (range, 34–51 months). The mean age at surgery was 8.5 years (range, 3.9–14.5y). The average length of discrepancy was 5.6 cm (range, 2.0–8.2 cm). Eight (8) cases had radiological findings of proximal tibial dysplasia, while the other 3 cases had not. The average distraction length gained was 5.3 cm (range, 3.5–8.0 cm) with a mean elongation rate of 21.4 % (range, 15–30 %). The Healing Index (HI) was 63.1 d/cm (range, 47–77 d/cm). In the 8 patients with proximal tibial dysplasia, 5 cases had lateral callus, 3 had central callus, and poor bone regeneration was observed in all of them with an average HI of 67 d/cm. In the other 3 patients without proximal tibial dysplasia, concave shaped callus was identified with an average HI of 52.7 d/cm. None of the patients had re-fracture, nonunion, axis deviation or angulation of the distraction area. Ankle joint stiffness was found in 2 of the patients. No evidence of knee contracture was detected. There were 5 cases with pin-tract infection which was managed by pin-tract nurse and oral administration of antibiotics.ConclusionsWe concluded that proximal tibial lengthening after initial union of CPT was effective for management of tibial shortening, however it was characterized by poor bone regeneration with different types of callus from normal, greater healing index and prolonged fixator wearing. We recommended that tibial lengthening could be considered when the limb length discrepancy (LLD) was more than 4 cm in younger children after primary union of CPT.
Highlights
The purpose of our retrospective study was to evaluate the preliminary result of distraction osteogenesis in patient with tibial shortening after initial union of Congenital Pseudarthrosis of the Tibia (CPT)
In this paper we present our experience of 11 CPT cases with proximal tibial lengthening using Ilizarov technique after initial union of tibial pseudarthrosis, and evaluated its preliminary outcome
All the CPT cases with tibial shortening after initial union which were managed by proximal tibial lengthening using Ilizarov technique were identified
Summary
The purpose of our retrospective study was to evaluate the preliminary result of distraction osteogenesis in patient with tibial shortening after initial union of Congenital Pseudarthrosis of the Tibia (CPT). Congenital pseudarthrosis of the tibia (CPT) is one of the most difficult orthopedics problems to manage in world, occurring in 1 in 190,000 live births [1]. [10] described bone transport with the lengthening through the physis in CPT patients to equalize limb length discrepancy. There were few reports on the indication and time window for tibial lengthening on CPT children [11]. In this paper we present our experience of 11 CPT cases with proximal tibial lengthening using Ilizarov technique after initial union of tibial pseudarthrosis, and evaluated its preliminary outcome. We aimed to describe the clinic features of tibial lenthening in CPT patients and provide guidance to such procedures
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