Noninfected Atrophic Tibial Pseudoarthrosis Threated With Ilizarov External Fixation And With Autogenous Intramedullary Spongioplasty

Abstract

We report a case report of a tibial aseptic, atrophic pseudoarthrosis. The patient was treated with immobilization of the lower extremity with a long-leg cast for a period of two and a half months. This treatment was interrupted because the patient developed thrombophlebitis of the affected leg. Possible reasons for the pseudoartrosis were: short period of immobilization, alcoholic malnutrition, and cigarette smoking. When the thrombophlebitis was cured, closed intramedullary fixation of the pseudoarthrosis was planned. The operation was converted later on to external fixation of the pseudoarthrosis according to Ilizarov, because it was not possible to introduce the intramedullary nail to the distal bone fragment with a closed technique, and because the surgical incision had to be made on the place where the pseudoarthrosis was. Second reason for the conversion to Ilizarov external fixation was the bad condition of the skin around the pseudoarthrosis. After the operation was finished, an idea for pseudoarthrosis spongioplasty with spongiosis from crista iliaca, together with fibular resection of one inch length, as a second surgical intervention came into mind. There was a pleasant surprise, because on the following x ray six weeks after the fixation, there was a calus where during the operation the guide wire for the intramedullary nail could not passed to the distal tibial fragment and was going outside. Maybe, during the unsuccessful attempts to pass the intramedullary nail`s guide wire, collateral autogenous intramedullary spongioplasty was made, i.e. spongiosis was brought (transplanted) with the guide wire from the proximal part of the tibia distally to the place of pseudoarthrosis. Three and a half months later the pseudoarthrosis of the tibia was cured and the Ilizarov external fixator was removed. The result of the operation was good. The patient was happy and he could walk normally without subjective difficulties. There was only discrete contracture of the left talocrural joint.