Internal fixation of congenital pseudarthrosis of the tibia with plate and bone graft

Abstract

Surgical Principles Stable internal fixation of the tibial fragments with correct axial alignment using a one-third tubular plate, a semitubular plate or a dynamic compression plate depending on the age of the patient and size and thickness of the tibial fragments. The plate is placed against one side of the tibia and fixed with screws to an autogenous corticocancellous bone graft which has been inserted on the opposite side of the same tibia. A strong autogenous bone graft from the contralateral tibia or the ipsilateral femur is essential because the screws necessary to keep the plate in place cannot be firmly anchored in the atrophic fragments alone. The thickened, fibrous periosteum tightly bound to the fragments around the pseudarthrosis must be resected. Autogenous bone grafts from the iliac crest or from the site of removal of the autogenous corticocancellous graft are added as well.