Combined surgery with intramedullary rod fixation across the ankle for the treatment of Crawford IV congenital pseudarthrosis of the tibia: a long-term follow-up study

Abstract

Background: The combined surgery with tibial intramedullary(IM) rod fixation across the ankle for the treatment of Crawford IV congenital pseudarthrosis of the tibia (CPT) is the most classic and effective surgical treatment method. The aim of this study is to explore the long-term clinical efficacy of combined surgery for the treatment of Crawford IV congenital pseudarthrosis of the tibia(CPT). Methods：A retrospective analysis was conducted on 82 cases of Crawford IV CPT who underwent combined surgical treatment with tibial intramedullary(IM) rod fixation through the ankle, to evaluate their long-term clinical efficacy and postoperative complications. Results：The average surgical age of the patient was (43.17 ± 13.40) months (range: 18-96 months), with an initial bone healing rate of 100%, and an average postoperative follow-up time of (119.78 ± 20.08) months (range: 84-146 months); At the last follow-up, there were a total of 20 cases of re fractures, including 15 cases in the complete insertion of IM rods into the tibial medullary cavity group, 2 cases in the tibial IM rod across the ankle fixation group, and 3 cases in the tibial IM rod removal group; There were a total of 28 cases of developmental bending and angular deformity of the tibial shaft after bone healing, including 26 cases in the complete insertion of IM rods into the tibial medullary cavity group, 0 cases in the tibial IM rod across the ankle fixation group, and 2 cases in the tibial IM rod removal group；All cases in the complete insertion of IM rods into the tibial medullary cavity group showed tibial IM rods deviating from the center of the medullary cavity, with a displacement rate of up to 100%. Conclusions：The combined surgery of tibial IM rod fixation across the ankle for the treatment of Crawford IV CPT has a high initial bone healing rate and definite therapeutic effect, but there are still many postoperative complications. The fixation status of tibial IM rods is an important influencing factor for tibial shaft developmental angular bending deformity and re fractures after initial bone healing.