Congenital pseudarthrosis of the tibia: treatment with intramedullary nail associated with external fixation

Despite the availability of many old and new treatments, healing ofcongenital pseudarthrosis of the tibia remains difficult. The methodof treatment is chosen according to the type of lesion (atrophic orhypertrophic), the age and the presence of associated problems(length discrepancy or angular deformities).Three methods can give good results.- vascularised fibular graft- intramedullary nailing (IN) associated with intertibiofibular graft(ITFG)- Ilizarov external fixation (EF)Association of these methods leads to better success rateSince 1996 we have been using IN with EF : stable external fixationpermitting compression leads to quick healing in 2 to 4months, internal fixation avoids iterative fracture. Surgical procedureincludes open excision of the pseudarthrodesis tissues tohealthy bone and reduction. When resection is important, bonetransfer is indicated.IN is done with standard or telescopic nail. When pseudarthrosis isvery distal, transplantor nailing is used. Ilizarov fixation is thenapplied with or without extension to the foot.In case of bone transfer or progressive lengthening, corticotomy isdone in the proximal metaphysis, far from dystrophic bone. Sixpatients and seven legs were operated on. Neurofibromatosis waspresent in 5 patients. Telescopic nailing was used 3 times. Addedbone graft (simple or ITFG) was used in some patients to thickenthe consolidated zone. Lengthening was done in two cases and bonetransfer in three cases. Consolidation was obtained in all patients in2 to 4 months. One patient was lost of control after consolidationand removal of EF. One patient needed IN removal for deep infectiondue to steroid injection in adjacent kystic lesion.