Plating following gradual realignment with the Taylor spatial frame for refractory congenital pseudarthrosis of the tibia: A novel technique

Abstract

Congenital pseudoarthrosis of the tibia (CPT) is an intractable pediatric orthopedic disease. This study aims to report short-term outcomes of our staged surgery: Gradual realignment with Taylor Spatial Frame (TSF) and conversion to a locking plate for Boyd classification type II CPT. Three males (mean age, 10.3 years) who had undergone past surgeries (average, 3.7) were included. The pseudoarthrosis was atrophic and mobile in all cases. The distal bone fragment was translocated to the proximal anterior direction, resulting in shortening of the leg. In the first surgery, TSF was applied spanning the pseudoarthrosis. A foot ring was placed on the foot, and the distal fragment of the tibia was fixed together with the foot. The deformity correction was initiated a day after surgery. TSF was converted to a locking plate after scheduled alignment was achieved, and cancellous bone of iliac crest was grafted. Bony union was achieved at a mean of 3 months, and patients walked independently after mean 56-month follow-up, without any complications. Although the treatment outcome after the vascularized fibular graft and the Ilizarov method is relatively successful, several issues require long-term relief, and the surgical procedure requires specialized techniques. The present method shortens the duration of external fixation, uses only simple surgical maneuvers, and prevents re-fracture by anatomical alignment and indwelling of the plate.