Intramedullary rod combined with ring external fixation for treatment of congenital pseudarthrosis of tibia in children

Abstract

Objective To describe the surgical technique of using intramedullary rods,Ilizarov ring external fixation device,and package-autogenously iliac bone graft for treatment congenital pseudarthrosis of tibia in children,and evaluate its clinical efficacy.Methods Since March 2007 to July 2010,51 cases with congenital pseudarthrosis of tibia underwent surgery in our center via combination of intramedullary rods,Ilizarov ring external fixation device and package-autogenously iliac bone graft.The average age of patients was 3.2 years (ranging from 10 months to 12.5 years),in which 31 cases (61％) of them were less than 3 years.Referring to the Crowford classification criteria,type Ⅱ was in 5 cases,type Ⅲ was in 3 cases and type Ⅳ was in 43 cases.Johnston clinical evaluation system and Ohnishi x ray grading standards were employed for evaluation of results.Results Average followed-up time were 1.6 years (ranging from 7 months to 3.1 years) in all patients,in which more than 2 year follow up was done in 19 cases.The average time of remove to Ilizarov external fixation device were 3.5 months (rangiug from 3 to 4,5 months).Johnston clinical evaluation indicated that grade I were in 26 cases,grade Ⅱ was in 21 eases and grade Ⅲ was in 4 cases.Furthermore,Ohnishi x-ray evaluation showed that pseudarthrosis of tibial healed in 42 cases,delayed healing was in 5 cases,non-healing in 4 cases.Conclusions The combination of intramedullary rod fixation,packageautogenous iliac bone graft and Ilizarov ring external fixation,is a reliable method for treatment of congenital pseudoarthrosis of tibia in children.Initial followed-up results indicate that it not only can significantly decrease healing time,but also reduce the incidence of re-fracture,especially suitable for the cases undergoing secondary surgery. Key words: Tibia; Fracture foxation, intramedullary; Bone transplantation; External fixators