{"id":307,"date":"2019-08-02T22:39:20","date_gmt":"2019-08-02T20:39:20","guid":{"rendered":"https:\/\/radler-ortho.com\/?page_id=307"},"modified":"2020-06-25T13:11:41","modified_gmt":"2020-06-25T11:11:41","slug":"pseudarthrosen","status":"publish","type":"page","link":"https:\/\/radler-ortho.com\/en\/kinder\/pseudarthrosen\/","title":{"rendered":"Congenital Pseudarthrosis of the Tibia (CPT)"},"content":{"rendered":"\n

Congenital\npseudarthrosis (non-united fractures) of the tibia (shin bone) is a rare (1:190,000)\nand complex disorder. Because of the low number of cases worldwide, only major\npediatric orthopedic centers have experience with this condition.<\/p>\n\n\n\n

I have been performing\ncorrective surgery for CPT for many years. Initially, fusing and healing the\npseudarthrosis are necessary. Then, prevention of refracture is accomplished through\nincreasing stability by inserting intramedullary rails or growing rods\n(Fassier-Duval telescopic rods; Pega Medical, Inc., Laval, Quebec, Canada) and applying\nbracing. I also correct many pretreated cases in which fusion has not been\nachieved that present with refracture and cases that require bone lengthening\nor correction of malalignment.<\/p>\n\n\n\n

Pseudarthrosis refers to\ninstability of a bone,\nwhich is usually found\nin the absence of\nhealing after a\nfracture. With CPT, the tibia (shin bone) is weakened\nin an\narea (mostly in the middle or lower part)\nand can\nbreak without\nany trauma. The nature\nof the\nbone in this disorder renders it extremely\ndifficult to heal\nthis fracture.\nEven after\nhealing, refracture is possible and\nmust be\nprevented by applying different\nmeasures. <\/p>\n\n\n\n

In cases of CPT, pseudarthrosis\nis not usually seen at birth but bending of the shin bone at the middle to\nlower third is often present. The pseudarthrosis usually becomes apparent\nonly after walking begins and mostly around the age of 3 years. Treatment has\ntraditionally consisted of preventing fracture and subsequent pseudarthrosis\nfor as long as possible by consequent bracing of the leg. This is still a\npossibility for mild forms without malalignment.<\/p>\n\n\n\n

When the bone bends more, and\nespecially after fracture, additional changes occur to the ankle and soft\ntissues. The changes are exceedingly difficult to correct later on and, in some\ncases, can be only partially corrected. For this reason, I recommend early\ncorrection, even before appearance of the pseudarthrosis.<\/p>\n\n\n\n

Intramedullary stabilization\nor plate fixation combined with bone grafting has a healing rate of\napproximately 50%. Microsurgical techniques that acquire bone from the healthy\nside show markedly better healing results. However, they are associated with\ncomplications in the area from which the bone has been obtained and risk of\nrefracture and\/or malalignment at the fusion site. <\/p>\n\n\n\n

The most successful\ntreatment to date starts with meticulous resection of the pseudarthrosis and\nthe pseudarthrosis membrane. Afterward, the alignment is corrected and an\nintramedullary nail or growing rod (Fassier-Duval telescopic rod) is inserted\ninto the bone.<\/p>\n\n\n\n

\n
\n
\"CPT
CPT before treatment<\/figcaption><\/figure>\n<\/div>\n\n\n\n
\n
\"CPT
CPT before treatment<\/figcaption><\/figure>\n<\/div>\n<\/div>\n\n\n\n
\n
\n
\"CPT
CPT after treatment<\/figcaption><\/figure>\n<\/div>\n\n\n\n
\n
\"CPT
CPT after treatment<\/figcaption><\/figure>\n<\/div>\n<\/div>\n\n\n\n

Another important\nprinciple recognized by Dr. In Ho Choi and developed into a treatment regime by\nDr. Dror Paley is to create a wide fusion\/bone connection between the tibia and\nfibula (shin bone and calf bone) to prevent refracture. <\/p>\n\n\n\n

Therefore, cancellous\nbone graft is harvested from the pelvis and mixed with a synthetic bone growth-stimulating\nfactor (bone morphogenetic protein [BMP]). At the pseudarthrosis area, a\nsandwich is created of the BMP cancellous bone graft and periosteum from the\npelvis. It induces healing and forms a fusion between the bones. <\/p>\n\n\n\n

Fixation is achieved using an angle-stable plate or external fixation frame<\/a>. An ankle-foot orthosis must be used until the end of growth to further protect the bones. Lengthening of the usually shortened tibia can be performed later on, in a separate surgery, or at the time of the initial surgery.<\/p>\n","protected":false},"excerpt":{"rendered":"

Congenital pseudarthrosis (non-united fractures) of the tibia (shin bone) is a rare (1:190,000) and complex disorder. Because of the low number of cases worldwide, only major pediatric orthopedic centers have experience with this condition. I have been performing corrective surgery for CPT for many years. Initially, fusing and healing the pseudarthrosis are necessary. Then, prevention … Continue reading Congenital Pseudarthrosis of the Tibia (CPT)<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"parent":19,"menu_order":10,"comment_status":"closed","ping_status":"closed","template":"","meta":[],"translation":{"provider":"WPGlobus","version":"2.12.2","language":"en","enabled_languages":["de","en"],"languages":{"de":{"title":true,"content":true,"excerpt":false},"en":{"title":true,"content":true,"excerpt":false}}},"amp_enabled":true,"_links":{"self":[{"href":"https:\/\/radler-ortho.com\/en\/wp-json\/wp\/v2\/pages\/307"}],"collection":[{"href":"https:\/\/radler-ortho.com\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/radler-ortho.com\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/radler-ortho.com\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/radler-ortho.com\/en\/wp-json\/wp\/v2\/comments?post=307"}],"version-history":[{"count":14,"href":"https:\/\/radler-ortho.com\/en\/wp-json\/wp\/v2\/pages\/307\/revisions"}],"predecessor-version":[{"id":1251,"href":"https:\/\/radler-ortho.com\/en\/wp-json\/wp\/v2\/pages\/307\/revisions\/1251"}],"up":[{"embeddable":true,"href":"https:\/\/radler-ortho.com\/en\/wp-json\/wp\/v2\/pages\/19"}],"wp:attachment":[{"href":"https:\/\/radler-ortho.com\/en\/wp-json\/wp\/v2\/media?parent=307"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}