Abstract
BackgroundDifficulty in obtaining union, recurrent fractures, and residual deformities remain the problems challenging the management of congenital pseudarthrosis of the tibia (CPT). We applied the “Eiffel Tower” double titanium elastic nails (TENs) in the existing combined approach, which takes advantages of TEN’s mechanical stability with the protection against refracture, Ilizarov’s high fusion rate with alignment control and the biologic environment provided by bone grafting for bony union. The results of this procedure are presented and discussed.MethodsSeventeen patients with CPT treated by combined surgery including pseudarthrosis resection, the “Eiffel Tower” double TENs technique, autogenous iliac bone grafting, and Ilizarov fixation between 2013 and 2019 were retrospectively investigated. Signs of bone union, limb length discrepancy (LLD), rate of refracture, and degree of residual deformities were reviewed. The AOFAS Ankle Hindfoot scale and measurement of ankle motion were used to evaluate ankle function. The mean follow-up time was 40.5 (11 to 91) months.ResultsThe mean age at index surgery was 6.2 (2.5 to 15) years. Union of the pseudarthrosis was achieved in 100% of cases. Among them, 15 (88.2%) patients obtained union of the pseudarthrosis on the first attempt (primary union). The average time to primary union was 3.8 (2 to 6) months. The rest 2 cases achieved union after additional surgeries (secondary union). In terms of complications, refracture occurred in 2 patients (11.8%) and 4 patients (23.5%) developed pin infection. The mean limb length discrepancy at the final follow up was 33.4 (6–141) mm. The average AOFAS score improved from 38.2 (27 to 51) pre-operatively to 77 (63 to 87) post-operatively (p < 0.01).ConclusionsThe “Eiffel Tower” double TENs technique is an ideal intramedullary fixation method in the surgical treatment of CPT. The combination of TENs technique with bone grafting and Ilizarov fixation has the advantages of early bone union, less injury on metaphysis, and early functional recovery.Level of evidenceLevel IV.
Highlights
Congenital pseudarthrosis of the tibia (CPT) is a rare and challenging orthopedic disease with over half of the patients associated with Neurofibromatosis Type 1 (NF-I) [1]
The combined surgical procedure takes the advantages of the external fixator’s high fusion rate with alignment control, protection against refracture provided by the internal fixation and the biologic environment facilitating bony union provided by bone grafting [2,3,4,5]
Combined surgical treatment including pseudarthrosis resection, double titanium elastic nails (TENs) technique, autogenous iliac bone grafting, and Ilizarov fixation was set as inclusion criteria
Summary
Congenital pseudarthrosis of the tibia (CPT) is a rare and challenging orthopedic disease with over half of the patients associated with Neurofibromatosis Type 1 (NF-I) [1]. The combined surgical procedure takes the advantages of the external fixator’s high fusion rate with alignment control, protection against refracture provided by the internal fixation and the biologic environment facilitating bony union provided by bone grafting [2,3,4,5]. We applied the “Eiffel Tower” double titanium elastic nails (TENs) in the existing combined approach, which takes advantages of TEN’s mechanical stability with the protection against refracture, Ilizarov’s high fusion rate with alignment control and the biologic environment provided by bone grafting for bony union. The results of this procedure are presented and discussed
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