Preliminary outcomes of intramedullary fixation of Kirschner's wire for congenital pseudarthrosis of tibia in children aged under 1 year

Abstract

Objective To explore the preliminary outcomes of intramedullary fixation of Kirschner's wire for congenital pseudarthrosis of tibia (CPT) in children aged <1 year. Methods From October 2014 to December 2017, intramedullary fixation of Kirschner's wire was performed for 15 CPT children aged <1 year. There were 10 boys and 5 girls with an average operative age of 5.6(2-12) months. The involved side was left (n=5) and right (n=10). There were proximal tibial dysplasia (n=5) and neurofibromatosis type 1 (n=11). Bone union rate, tibial alignment, limb length discrepancy (LLD), valgus deformity of ankle and frequency of refracture were recorded and analyzed. Results The average follow-up period was 22(9-48) months. One case achieved initial healing at 7 months postoperatively. Fifteen cases achieved an improvement of mechanical axis and 7/15 cases (47%) had normal mechanical axis. Eight cases had residual angular deformity with an average of 6.6(4-9) degrees and 13(86%, 13/15) had an average LLD of 1.5(0.6-5.0) cm. During follow-ups, none of them had ankle valgus and proximal tibia valgus. Conclusions For Crawford type IV congenital tibial pseudarthrosis under 1 year of age, intramedullar fixation of Kirschner's wire may restore and maintain tibial mechanical axis. It helps children to learn to stand and walk under the protection of brace, prevents the further aggravation of bone atrophy and tibial angulation deformity caused by tibial pseudarthrosis and reduces the difficulty of combined surgery. Key words: Child; Congenital pseudarthrosis of tibia; Kirschner wire intramedullary fixation