CONGENITAL PSEUDOARTHROSIS TIBIA IN CHILD WITH NEUROFIBROMATOSIS TYPE 1 TREATED WITH THE COMBINED VASCULARIZED FIBULAR GRAFT AND ELASTIC STABLE INTRAMEDULLARY NAIL (ESIN)

Abstract

Background: CPT is a disorder characterized by a nonunion tibial fracture that occurs spontaneously or after trivial trauma. Therapy usually includes surgical management and aims to gain lifetime bony union, avoid leg length discrepancy, and to prevent mechanical axis deviation, surrounding soft tissue lesion, joint stiffness, and pathological fracture. CPT remains to be a challenging orthopedic issue due to the difficulty to gain and to maintain the union and a functional limb. The combined VFG and ESIN is one of our preferred method in Surabaya.Case: A 13-year-old boy complained about crooked right lower leg since 1-year old, and fractured at 11 years old. In January 2014, the patient underwent ORIF ESIN combined with free VFG. The patient got bony union 24 months after the ORIF ESIN and VFG surgery. RUST modified scoring system showed a score out of 3, which signified that there was a radiographically significant union at the site of tibial pseudoarthrosis.Discussion: The combined VFG and ESIN is to maintain bony union and stability. Intramedullary fixation offers a good tibial alignment and prevents refracture. Hypertrophy and the vitality of VFG support the bony union. The level of success rate in both primary and secondary union is a benefit shown after VFG therapy.Conclusion: The combination of VFG after complete resection of tibial pseudoarthrosis and ESIN in this case report showed a success in achieving and maintaining the bony union, thus this therapy became one of the preferences as a suitable standard therapy that we use in our hospital institution.