Treatment of deformities in patients with healed congenital pseudarthrosis of the tibia

Abstract

Background. Correction of deformities and lengthening of the lower extremities in patients with healed congenital pseudarthrosis of tibia (cCPT) is associated with certain characteristics, difficulties, and complications. But even the restoration of the anatomy and length of the tibia does not solve the problem of further recurrence of the deformity. Aim. This study aimed to evaluate the results of the correction of deformities of the tibia in patients with congenital pseudarthrosis of the tibia after achieving union by using external fixation and guided growth. Materials and methods. The results of treatment of 19 patients with cCPT, aged 4–15 years, which were observed in the Department of the Turner Scientific Research Institute from 2013 to 2018 years, were analyzed. We analyzed the types of deformities before the stage of correction deformities, evaluated the accuracy of the correction deformities after two-level osteotomies of the tibia, and used ortho-SUv passive computer navigation. External fixation index and number of complications were also determined. The type and number of recurrence of deformities and the timing of their detection were analyzed. Results. On the basis of clinical classification, patients with cCPT had complex deformities of the affected lower limb. The accuracy of the correction of deformities was 84% at the end of the correction period. The amount of elongation was 4.5 ± 1.5 cm. The IEF was 64.3 ± 40.6 days/cm. After the end of the external fixation period, deformities recurred in 100% of cases. In 17 patients, temporary hemiepiphysiodesis of the tibial bones, the second stage, was performed. The accuracy of the correction was 100%. The period of correction ranged from 12 to 14 months. Discussion. In the literature, we found no studies investigating the accuracy of the deformity correction, the choice of the level of osteotomies in patients with cCPT. Considering these data and the experience of the senior author of the publication, we performed two osteotomies of the tibia, outside the consolidation zone of the pseudarthrosis. High accuracy of the correction deformities was achieved in conjunction with the use of the ortho-SUv frame. Conclusion. The analysis showed that the deformity relapsed in 100% of children as the child grows, regardless of the accuracy of the deformity correction in children after achieving union CPT. Hemiepiphysiodesis is an effective treatment for this complication.