Pseudarthrosis Of Tibia Research Articles

Free vascularized fibular graft for tibial pseudarthrosis in neurofibromatosis.

Four patients with neurofibromatosis and a dysplastic type of congenital pseudarthrosis of the tibia were treated by resection of the lesion and reconstruction of the extremity with a free vascularized fibular graft. Solid union of the graft was achieved within 3 months in 3 children. However, valgus malalignment of the tibia progressed in all 3. One child was treated with resection of a lateral fibrotic band and another with distal tibial epiphysial distraction and realignment. In the fourth patient, who was skeletally mature, a nonunion developed proximally.

Congenital Pseudarthrosis of the Tibia Associated with Cleidocranial Dysostosis and Osteogenesis Imperfecta

A neonatal boy with cleidocranial dysostosis presented with congenital pseudarthrosis of the tibia. Clinical observation later revealed he also had osteogenesis imperfecta. The osteogenesis imperfecta was classified as Type I and the congenital tibial pseudarthrosis as Type II. Cleidocranial dysostosis, osteogenesis imperfecta, and congenital pseudarthrosis of the tibia have not been previously reported to coexist in one individual.

Preliminary Observations on Epiphyseal Growth Rate in Congenital Pseudarthrosis of Tibia After Free Vascularized Fibular Graft

Observations were made on the growth rate of proximal and distal tibial epiphyseal growth plates in three children treated by free vascularized fibular grafts for congenital pseudarthrosis of the tibia. Postoperative measurements show that the distal tibial epiphysis can grow faster than the proximal epiphysis; the successful transfer of vascularized fibula may increase blood supply to the distal tibial epiphyseal plate, thus stimulating its growth.

Neurofibromatosis in Children

The clinical diagnosis of neurofibromatosis in childhood will usually be based on the presence of numerous café-au-lait spots. Early diagnosis allows for continuing follow-up and appropriate counselling. Symptomatic therapy can be provided if necessary. The disorder has a tendency via its mesodermal route to affect almost every system in the body; however, few laymen have even heard of the disorder and, except for the "Elephant Man" notoriety, are totally unaware of it, whereas muscular dystrophy, cystic fibrosis, and Down syndrome although occurring less frequently are well known to the general public. The management of neurofibromatosis in children covers an extremely wide spectrum: at times the management appears to be simple, involving little more than clinical evaluation and simple investigations. However, in view of the protean manifestations of the condition, a complete history including family history is obligatory, and investigation must include radiographic studies of the abdomen, chest, spine, and skull, the latter to include special views of the orbits and optic foramina. My investigation of this disorder has been extremely frustrating because of the progressive character of the disease. Nothing seems to alter the natural course of the disease. I cannot say that my investigative efforts have revealed any breakthroughs in treatment. An aggressive surgical approach to the myriad of lesions associated with this disease, especially neuromata or segmental problems, is probably advisable. The early treatment of tibial pseudarthrosis by polyprophylene orthotic and pulsating electromagnetic fields shows encouraging results over the short course, although I am not so sure as to whether or not the patients would do as well with the custom fit orthotic with or without the electronics. Early stabilization of spinal deformity has proven to be more than moderately successful and is strongly recommended following appropriate intraspinal evaluation. The management of tumors of the brain and spinal cord, as well as those associated with limb hypertrophy and congenital tibial pseudarthrosis, is undergoing innovations at this time which may result in a better cure rate. Procedures include the use of CT to evaluate tumors [Coleman et al. have attempted to differentiate neurofibromas from neurofibrosarcoma by contrast enhancement methods], the use of CO2 lasers to remove previously inoperable CNS tumors, microvascular bone transplantation and pulsating electromagnetic field to treat pseudarthrotic bones.4+he National

Treatment of infected tibial pseudarthrosis by external fixation with the Wagner device.

We analyzed our experience with infected tibial pseudoarthrosis which resulted in a therapeutic plan for a radical operation or a step-by-step method, depending on the type of pseudarthrosis (PS), the severity of the infection, and the skin damage. We think that external fixation with the Wagner device is the procedure of choice. Owing to its simplicity and good stability, it is possible to treat the PS and the infection and to obtain good final results.

Comparison of the Ordinary , Vascularized Bone Grafting and Electrical Stimulation in the Treatment of the Congenital Pseudarthrosis of Tibia

Comparison of the Ordinary , Vascularized Bone Grafting and Electrical Stimulation in the Treatment of the Congenital Pseudarthrosis of Tibia

Pseudarthrosis of a Tibial Plateau Fracture

In an elderly woman a tibial condylar pseudarthrosis was angulated with disabling pain, significant deformity, and progressive articular deterioration. The treatment of this non-union consisted of arthrotomy, mobilization of the ununited medial condyle, slight over-elevation of the tibial plateau, iliac bone grafting to reconstitute loci of bone loss, and rigid interfragmentary and buttress plate fixation. Postoperative management consisted of early knee motion and delayed weight-bearing to facilitate functional restoration of the extremity. Within 3 months, union occurred in anatomic position.

Preventive treatment of congenital pseudarthrosis of tibia

If an osteotomy is carried out in a child with congenital angulation of the tibia with segmental sclerosis, a pseudarthrosis develops in many cases. This should be prevented by a bone-graft operation along the concave side of the tibia. The results described illustrate this contention.

Periosteal pedicle grafting in dogs.

An experimental model was designed to find a theoretical solution to the clinical problem of congenital tibial pseudarthrosis in children. The osteogenic properties of periosteum having been accepted, paired pedicled flaps of periosteum were raised from the subcutaneous surface of the tibia, tubed and anastomosed in a series of young dogs. In the last twenty-four consecutive cases the rate of complete ossification in these tubes rose to one in three. In the later stages of the work, in addition to the construction of periosteal tube grafts, pseudarthroses were induced in the middle third of each canine tibia in order to see if hypertrophy would occur under the stress of weight-bearing. It was found that in each of twenty-four specimens some hypertrophy occurred in the ossified periosteal tube grafts, and in three of the specimens this hypertrophy was associated with complete ossification of the graft that by-passed the pseudarthrosis.

Congenital pseudarthrosis and bowing of the fibula.

1. The cases of four children who presented with bowing or pseudarthrosis of the fibula only, are described. 2. There is a gradation in the severity and significance of this condition. There may be fibular bowing without fibular pseudarthrosis; fibular pseudarthrosis without ankle deformity; fibular pseudarthrosis with deformity but without the late development of tibial pseudarthrosis; or fibular pseudarthrosis with the late development of tibial pseudarthrosis. 3. Proper management is dependent on a knowledge of this range of conditions.

THE USE OF A COMPOSITE PEDICLE GRAFT FOR PSEUDARTHROSIS OF THE TIBIA

Three children with tibial pseudarthrosis were treated with cutaneous-bone pedicle grafts in order to determine whether such a method would constitute a successful form of therapy for this condition at this age level. Although the principle involved appeared sound, the operation as described is not recommended. Union between the graft and the upper tibial fragment occurred rapidly. Technical difficulties may have been the cause of the delay in fusion at the lower end. It may be possible to overcome these difficulties by the use of a bone pedicle graft from another area, such as the ulna. Accurate approximation of the graft to the tibial fragments at the time of the initial transfer might then be possible. This would appear advantageous. These results have been placed on record, so that the obvious errors may be avoided by others who may carry forward the technique. It was first used without previous knowledge that a procedure based on the same principle had been employed by European orthopaedic surgeons at the turn of the century.

PSEUDARTHROSIS OF THE TIBIA IN CHILDHOOD

1. The results of the by-pass grafting operation in eleven cases of pseudarthrosis of the tibia in childhood are presented. 2. The operation was successful in securing sound bone union in nine cases, and unsuccessful in two. 3. The causes of failure in the two unsuccessful cases are analysed. 4. The possible causes of occurrence and persistence of tibial pseudarthrosis in childhood are discussed. 5. It is suggested that the pseudarthrosis results from a fatigue fracture of a congenitally abnormal tibia, but that its persistence depends entirely on mechanical factors. 6. There is evidence to suggest that the underlying congenital abnormality may arise from dysplasia of the mesenchyme.