Application of telescopic rod during combined surgical technique for congenital pseudarthrosis of the tibia in children

Abstract

Objective To explore the preliminary effect of telescopic rod during combined surgical technique for congenital pseudarthrosis of the tibia (CPT) in children. Methods A retrospective study was performed for 15 children with Crawford type IV CPT undergoing combined surgical technique and telescopic rod from January 2017 to May 2018. There were 12 boys and 3 girls with an average operative age of 51.6 (16-126) months. The lesions were left (n=7) and right (n=8). The concurrent conditions were proximal tibia dysplasia (n=7) and neurofibromatosis type 1 (n=12). Combined surgical technique and telescopic rod included excision of pseudarthrosis, intramedullary rod insertion, installation of Ilizarov's fixator, tibio-fibular cross union and wrapping autogenic iliac bone graft. The incidence of refracture, ankle valgus, tibial valgus and limb length discrepancy (LLD) were recorded during an average follow-up period of 23.3(12-28) months. Results All children achieved primary union. The average primary union time was 4.5(4.0-5.6) months. Nine cases showed LLD with an average extremity length of 1.1(0.5-2.0) cm; ankle valgus (n=1; 18°) and proximal tibial valgus (n=3; 10°, 5° & 6°), telescopic rod displacement (n=6) and epiphyseal plate tethered (n=2). There was no instance of refracture during follow-ups. Movements of ankle joint were all normal with an average dorsiflexion 24°(20°~30°) and with an average plantar flexion 43°(40°~50°) and the function of ankle joint was normal. Conclusions The primary healing rate of CPT in children is high by operating with telescopic rod. However, intramedullary rod displacement still occurs. Key words: Children; Congenital pseudarthrosis of tibia; Telescopic rod; Initial effect