Preliminary Study Of Treatment Choice For Congenital Pseudarthrosis Of The Tibia Of Children Under7

Objective To probe the treatment choice for congenital pseudarthrosis of the tibia. And to introduce the treatment of congenital pseudarthrosis of the tibia with Ilizarov technique and intramedullary fixation, evaluate the clinical experience and the result.Method8cases collected in our hospital since2006are involved in the study,6male, and2femal., ranging from2months old to7years and2months old, and the average year is4years and3months. Lesion is located in the right side of3cases, and in the left sied of5cases. Classificated by Boyd typing, type Ⅱ for1, type Ⅲ for1, type Ⅳ for3, and type Ⅴ for3.4cases have experienced operation for once,1experienced for twice, and the other3haven’t experienced any operation.1case is protected by brace.2are treated by intramedullary nailing only.1is treated by intramedullary nailing until healing first, and Ilizarov external fixation is performed secondly to lengthen the limb.4treated by Ilizarov external fixation along with intramedullary fixation, in which Simultaneous lengthening of the proximal tibia is performed in1cases.Result Bony union are achieved in4cases who are treated by Ilizarov technique and1case treated by intramedullary nailing. The average healing time is7.5months.1of the5refractured after removing brace.1unhealed after several times of operation, and second pseudarthrosis is formed at the level of lengthening part. Union is delayed on the other2cases.20°valgus deformity of ankle can be found in2patients, and15°ankle varus in another.1case bends to anterior at a level of30°,4cases bend to lateral of10°-15°, average12°. Limb shortening of2cm-10cm(average4cm) exist on6cases. According to Johnston clinical grading system, grade Ⅰ3cases, grade Ⅱ3cases, grade Ⅲ2cases. According to the Ohnishi X line grading standards, pseudarthrosis healing in5cases, delayed union in2cases, nonunion in1case. These cases are still under the protection of walking brace.Conclusion Intramedullary nailing for children under5will maintain the lines of force effectively. Ilizarov technique along with intramedullary fixation is better when children are over5. Amputation is unavoidable if the patient has experienced several times of operation or the limb is too short than contralateral side.