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Radler C, Calder P, Eidelman M, Horn J, Kold S, Langendörfer M, Manner HM, Sedki I, Vogt B. What's new in pediatric lower limb reconstruction? J Child Orthop 2024; 18:349-359. [PMID: 39100980 PMCID: PMC11295377 DOI: 10.1177/18632521241258351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 04/15/2024] [Indexed: 08/06/2024] Open
Abstract
The last years brought many advances relevant to lower limb reconstruction. It feels like guided growth has been looked at from every angle, and still there are new emerging concepts like rotational guided growth waiting to be validated. New hexapod external devices are more accurate and easier to use, and new unilateral fixators allow for more versatile and stable fixation and lengthening. Intramedullary nail lengthening has found its place as a standard procedure for various diagnoses in children and young adults. First results of new and exciting approaches like extramedullary implantable nail lengthening and lengthening plates have been reported. Pharmaceutical treatment has changed the course of certain diseases and must be integrated and considered when making a reconstructive treatment plan. As reconstructive surgery is rapidly advancing so are the technical options for prosthetic fitting, which makes it difficult for caregivers as well as for parents to make the decision between reconstruction and amputation surgery for the most severe cases of congenital deficiencies. This review is highlighting new developments of lower limb reconstruction and is reviewing the current literature.
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Affiliation(s)
- Christof Radler
- Department of Pediatric Orthopaedics and Adult Foot and Ankle Surgery, Orthopaedic Hospital Speising, Vienna, Austria
| | | | - Mark Eidelman
- Ruth Children’s Hospital, Rambam Health Care Campus, Technion Faculty of Medicine, Haifa, Israel
| | - Joachim Horn
- Section of Children’s Orthopaedics and Reconstructive Surgery, Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Søren Kold
- Department of Orthopaedics, Aalborg University Hospital, Aalborg, Denmark
| | - Micha Langendörfer
- Department of Paediatric Orthopaedics, Asklepios Klinik Sankt Augustin, Sankt Augustin, Germany
| | - Hans Michael Manner
- Department of Paediatric Orthopaedics, Schulthess Clinic, Zurich, Switzerland
| | - Imad Sedki
- Royal National Orthopaedic Hospital, London, UK
| | - Bjoern Vogt
- Paediatric Orthopaedics, Deformity Reconstruction and Foot Surgery, Muenster University Hospital, Muenster, Germany
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Cariello V, Smaldone MC, Durante A, Pizzicato P, Rossi A, Minelli R, Ferrara D, Esposito F, Zeccolini M, Rossi E. Congenital tibial pseudarthrosis: A challenge in pediatric radiology. Radiol Case Rep 2024; 19:2502-2507. [PMID: 38585392 PMCID: PMC10997800 DOI: 10.1016/j.radcr.2024.03.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 03/14/2024] [Accepted: 03/18/2024] [Indexed: 04/09/2024] Open
Abstract
Congenital pseudarthrosis of the tibia (CPT) is a rare disorder affecting the skeletal system in pediatric population with an estimated incidence of 1:140,000 to 1:250,000 newborns. It is characterized by deformity of the tibia, including anterolateral bowing of the bone diaphysis and/or narrowing of the medullary canal, leading to instability or fracture. CPT can be either idiopathic or associated with underlying conditions such as type 1 neurofibromatosis (NF1), fibrous dysplasia, or Campanacci's osteofibrous dysplasia. Diagnosis is based on clinical and imaging findings, using conventional radiography and magnetic resonance imaging (MRI). The disorder is characterized by recurrent pathological fractures of the tibia or fibula during childhood, often beginning by the age of 2 years. Treatment options include surgical and nonsurgical management.
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Affiliation(s)
- Valentina Cariello
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Piazza Miraglia, Naples 80138, Italy
| | - Maria C. Smaldone
- Department of Radiology, AORN “Santobono-Pausilipon”, Via Posillipo 226, Naples 80123, Italy
| | - Adele Durante
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Piazza Miraglia, Naples 80138, Italy
| | - Paolo Pizzicato
- Department of Radiology, AORN “Santobono-Pausilipon”, Via Posillipo 226, Naples 80123, Italy
| | - Antonio Rossi
- University “Campus Biomedico”, Via Álvaro del Portillo 21, Rome 00128, Italy
| | - Rocco Minelli
- Department of Radiology, University of Molise “Unimol”, Via Francesco De Sanctis 1, Campobasso 86100, Italy
| | - Dolores Ferrara
- Department of Radiology, AORN “Santobono-Pausilipon”, Via Posillipo 226, Naples 80123, Italy
| | - Francesco Esposito
- Department of Radiology, AORN “Santobono-Pausilipon”, Via Posillipo 226, Naples 80123, Italy
| | - Massimo Zeccolini
- Department of Radiology, AORN “Santobono-Pausilipon”, Via Posillipo 226, Naples 80123, Italy
| | - Eugenio Rossi
- Department of Radiology, AORN “Santobono-Pausilipon”, Via Posillipo 226, Naples 80123, Italy
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Liu Y, Liu K, Tan Q, Yang G, Huang Y, Zhu G, Wu J, Mei H. Comparative study of different extendable intramedullary rods combined with surgery in the treatment of congenital pseudarthrosis of the tibia. Orphanet J Rare Dis 2024; 19:208. [PMID: 38773525 PMCID: PMC11110408 DOI: 10.1186/s13023-024-03202-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 05/05/2024] [Indexed: 05/24/2024] Open
Abstract
BACKGROUND When using traditional extensible intramedullary rods to treat congenital pseudarthrosis of the tibia (CPT), there were cases of re-fracture and internal fixation fracture. Therefore, the authors propose a research hypothesis that a thicker distal extensible intramedullary rod can better protect the tibia and reduce the incidence of refracture PURPOSE: To investigate the clinical efficacy of new and traditional extensible intramedullary rods in the treatment of CPT in children METHODS: From January 2017 to December 2021, the clinical data of 49 children with CPT who were treated with traditional extensible intramedullary rod combined surgery (group A) and new extensible intramedullary rod combined surgery (group B) in our hospital were collected. Inclusive criteria: ① Crawford type IV CPT children; ② The operation was performed by the same team. EXCLUSION CRITERIA patients with multiple tibial angulation. During follow-up, the initial healing, proximal tibial valgus, tibial length, ankle valgus, refracture and intramedullary rod displacement of CPT children in the two groups were evaluated RESULTS: It was a retrospective investigation. In group A, 26 cases met the inclusion criteria, 24 cases achieved primary healing, with an primary healing rate of 92%, including 1 case of nonunion due to osteomyelitis complications after surgery, and 1 case of delayed healing, with an average healing time of 4.7 ± 0.8 months. 17 cases (68%) had unequal tibia length, with an average difference of 1.6 ± 0.8 cm. Ankle valgus occurred in 10 cases (40%) with an average of 14.4°±4.8°; Proximal tibial valgus occurred in 6 cases (24%) with an average of 7 °± 1.8 °. 20 cases (80%) had tip of the rod migration.10 cases (40%) had re-fracture; The average follow-up time was 2.4 ± 0.4 years. In group B, 22 patients achieved primary healing, and the primary healing rate was 95%, including 1 case with delayed healing. The average healing time was 4.7 ± 1.7months. 14 cases (61%) had unequal tibia length, with an average difference of 1 ± 0.5 cm. Ankle valgus occurred in 4 cases (17%) with an average of 12.3 °±4.9°; The proximal tibia valgus occurred in 9 cases (39%), with an average of 7.7 °±2.5 °. 14 cases (61%) had new type of intramedullary rod displacement. 3 cases (13%) had re-fracture; The average follow-up time was 2.3 ± 0.6years CONCLUSION: Compared with the traditional extended intramedullary rod combined operation, the new type of extended intramedullary rod combined operation has a lower incidence of re-fracture after CPT, but it still needs to be verified by large sample and multi-center research.
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Affiliation(s)
- Yaoxi Liu
- Department of pediatric orthopedics, The Affiliated Children's Hospital Of Xiangya School of Medicine,Central South University (Hunan children's hospital), Hunan Provincial Key Laboratory of Pediatric Orthopedics, The school of pediatrics,University of South China, 86 Ziyuan Road, Changsha City, Hunan Province, 410007, People's Republic of China
| | - Kun Liu
- Department of pediatric orthopedics, The Affiliated Children's Hospital Of Xiangya School of Medicine,Central South University (Hunan children's hospital), Hunan Provincial Key Laboratory of Pediatric Orthopedics, The school of pediatrics,University of South China, 86 Ziyuan Road, Changsha City, Hunan Province, 410007, People's Republic of China.
| | - Qian Tan
- Department of pediatric orthopedics, The Affiliated Children's Hospital Of Xiangya School of Medicine,Central South University (Hunan children's hospital), Hunan Provincial Key Laboratory of Pediatric Orthopedics, The school of pediatrics,University of South China, 86 Ziyuan Road, Changsha City, Hunan Province, 410007, People's Republic of China
| | - Ge Yang
- Department of pediatric orthopedics, The Affiliated Children's Hospital Of Xiangya School of Medicine,Central South University (Hunan children's hospital), Hunan Provincial Key Laboratory of Pediatric Orthopedics, The school of pediatrics,University of South China, 86 Ziyuan Road, Changsha City, Hunan Province, 410007, People's Republic of China
| | - Yiyong Huang
- Department of pediatric orthopedics, The Affiliated Children's Hospital Of Xiangya School of Medicine,Central South University (Hunan children's hospital), Hunan Provincial Key Laboratory of Pediatric Orthopedics, The school of pediatrics,University of South China, 86 Ziyuan Road, Changsha City, Hunan Province, 410007, People's Republic of China
| | - Guanghui Zhu
- Department of pediatric orthopedics, The Affiliated Children's Hospital Of Xiangya School of Medicine,Central South University (Hunan children's hospital), Hunan Provincial Key Laboratory of Pediatric Orthopedics, The school of pediatrics,University of South China, 86 Ziyuan Road, Changsha City, Hunan Province, 410007, People's Republic of China
| | - Jiangyan Wu
- Department of pediatric orthopedics, The Affiliated Children's Hospital Of Xiangya School of Medicine,Central South University (Hunan children's hospital), Hunan Provincial Key Laboratory of Pediatric Orthopedics, The school of pediatrics,University of South China, 86 Ziyuan Road, Changsha City, Hunan Province, 410007, People's Republic of China
| | - Haibo Mei
- Department of pediatric orthopedics, The Affiliated Children's Hospital Of Xiangya School of Medicine,Central South University (Hunan children's hospital), Hunan Provincial Key Laboratory of Pediatric Orthopedics, The school of pediatrics,University of South China, 86 Ziyuan Road, Changsha City, Hunan Province, 410007, People's Republic of China.
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Jeong CH, Lim SY, Um JE, Lim HW, Hwang KH, Park KM, Yun JS, Kim D, Huh JK, Kim HS, Yook JI, Kim NH, Kwak YH. Micellized protein transduction domain-bone morphogenetic protein-2 accelerates bone healing in a rat tibial distraction osteogenesis model. Acta Biomater 2023; 170:360-375. [PMID: 37611691 DOI: 10.1016/j.actbio.2023.08.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 08/13/2023] [Accepted: 08/15/2023] [Indexed: 08/25/2023]
Abstract
The clinical application of growth factors such as recombinant human bone morphogenetic protein-2 (rh-BMP-2), for functional bone regeneration remains challenging due to limited in vivo efficacy and adverse effects of previous modalities. To overcome the instability and short half-life of rh-BMP-2 in vivo, we developed a novel osteogenic supplement by fusing a protein transduction domain (PTD) with BMP-2, effectively creating a prodrug of BMP-2. In this study, we first created an improved PTD-BMP-2 formulation using lipid nanoparticle (LNP) micellization, resulting in downsizing from micrometer to nanometer scale and achieving a more even distribution. The micellized PTD-BMP-2 (mPTD-BMP-2) demonstrated improved distribution and aggregation profiles. As a prodrug of BMP-2, mPTD-BMP-2 successfully activated Smad1/5/8 and induced mineralization with osteogenic gene induction in vitro. In vivo pharmacokinetic analysis revealed that mPTD-BMP-2 had a much more stable pharmacokinetic profile than rh-BMP-2, with a 7.5-fold longer half-life. The in vivo BMP-responsive element (BRE) reporter system was also successfully activated by mPTD-BMP-2. In the in vivo rat tibia distraction osteogenesis (DO) model, micro-computed tomography (micro-CT) scan findings indicated that mPTD-BMP-2 significantly increased bone volume, bone surface, axis moment of inertia (MOI), and polar MOI. Furthermore, it increased the expression of osteogenesis-related genes, and induced bone maturation histologically. Based on these findings, mPTD-BMP-2 could be a promising candidate for the next-generation osteogenesis drug to promote new bone formation in DO surgery. STATEMENT OF SIGNIFICANCE: This study introduces micellized bone morphogenetic protein-2 (mPTD-BMP-2), a next-generation osteogenic supplement that combines protein transduction domain (PTD) and nano-sized micelle formulation technique to improve transduction efficiency and stability. The use of PTD represents a novel approach, and our results demonstrate the superiority of mPTD-BMP-2 over rh-BMP-2 in terms of in vivo pharmacokinetic profile and osteogenic potential, particularly in a rat tibial model of distraction osteogenesis. These findings have significant scientific impact and potential clinical applications in the treatment of bone defects that require distraction osteogenesis. By advancing the field of osteogenic supplements, our study has the potential to contribute to the development of more effective treatments for musculoskeletal disorders.
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Affiliation(s)
- Cheol Hee Jeong
- Department of Oral Pathology, Yonsei University College of Dentistry, Seoul, 03722, Korea; Oral Cancer Research Institute, Yonsei University College of Dentistry, Seoul, 03722, Korea
| | - Song-Yi Lim
- Department of Orthopedic Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, 05505, Korea
| | - Jo Eun Um
- MET Life Science, Seoul, 03722, Korea
| | - Hyo Won Lim
- Department of Orthopedic Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, 05505, Korea
| | | | - Kyeong-Mee Park
- Department of Advanced General Dentistry, Yonsei University College of Dentistry, Seoul, 03722, Korea
| | - Jun Seop Yun
- Department of Oral Pathology, Yonsei University College of Dentistry, Seoul, 03722, Korea; Oral Cancer Research Institute, Yonsei University College of Dentistry, Seoul, 03722, Korea
| | - Dohun Kim
- Department of Orthopedic Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, 05505, Korea
| | - Jong-Ki Huh
- Department of Oral and Maxillofacial Surgery, Gangnam Severance Hospital, Yonsei University College of Dentistry, Seoul, 06273, Korea
| | - Hyun Sil Kim
- Department of Oral Pathology, Yonsei University College of Dentistry, Seoul, 03722, Korea; Oral Cancer Research Institute, Yonsei University College of Dentistry, Seoul, 03722, Korea; MET Life Science, Seoul, 03722, Korea
| | - Jong In Yook
- Department of Oral Pathology, Yonsei University College of Dentistry, Seoul, 03722, Korea; Oral Cancer Research Institute, Yonsei University College of Dentistry, Seoul, 03722, Korea; MET Life Science, Seoul, 03722, Korea
| | - Nam Hee Kim
- Oral Cancer Research Institute, Yonsei University College of Dentistry, Seoul, 03722, Korea; MET Life Science, Seoul, 03722, Korea.
| | - Yoon Hae Kwak
- Department of Orthopedic Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, 05505, Korea.
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Mastantuoni G, Aulisa AG, Giordano M, Savignoni P, Toniolo RM, Falciglia F. Anterolateral congenital tibial bowing: case report. Front Pediatr 2023; 11:966358. [PMID: 37181425 PMCID: PMC10166803 DOI: 10.3389/fped.2023.966358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 04/04/2023] [Indexed: 05/16/2023] Open
Abstract
Background The treatment of congenital curvatures (bowing) of the tibia still represents a challenging problem for all pediatric orthopedic surgeons because of its unpredictable course, especially if pseudoarthrosis occurs after a pathologic fracture of the tibia. Case presentation We describe the case of a child affected by an isolated curvature of his left leg. The congenital malformation was discovered at birth and no other pathological clinical finding was present. The first x-ray showed the presence of a congenital curvature of the tibia of the antero-lateral type. He was born in another country (Romania) and when he first came to our clinical observation at the Orthopedic and Traumatology Department, Pediatric Hospital "Bambino Gesu'", Rome, the child was 14 months of age and had already started walking. Only a leg discrepancy of about 2 cm was present with consequent pelvis obliquity. At the beginning, we prescribed external lower limb orthoses and a simple shoe rise to prevent a tibial pathologic fracture and reduce pelvic obliquity. At periodical clinical follow-up visits and despite the external lower limb orthoses prescribed, a progressive worsening of the severe congenital tibial curvature was observed together with signs and symptoms, such as pain and limping, that suggested an objective "pre-fracture stage" of the tibial curvature; we decided to perform surgery. At the time of surgery, the child was three and a half years old. Surgery consisted of a double osteotomy, both of the fibula and of the tibia. Subtraction of the distal meta-diaphyseal portion of the fibula and tibial osteotomy in Correspondence: of the major anterolateral curvature. The tibial osteotomy was then stabilized by an internal Rush rod inserted proximally to the tibia under the cartilage growth plate and made it end inside the distal tibial epiphysis, crossing the distal tibial cartilage growth plate, preserving the ankle joint. Results The patient had an immediately excellent outcome. The tibial osteotomy site healed perfectly. At periodical orthopedic follow-up visits, the child was found to be always better. No clinical significative evidence of growth disturbances, due to the Rush rod that crossed the distal tibial cartilage growth plate, were noted. X-rays showed that the Rush rod progressively migrated with tibial growth together with the tibial bone growth, always getting further away from the distal tibial cartilage growth plate. Moreover, even the leg-length discrepancy and the pelvic obliquity improved. After an eight-year follow up, the patient, now a young boy of 11 and a half years, has an excellent outcome. Conclusions Our case report undoubtedly provides further important information for the treatment of these rare congenital disorders. In particular, it highlights the management of the "pre-fracture stage" in a severe congenital tibial antero-lateral curvature in a very young child and describes the surgical technique performed.
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Affiliation(s)
| | - Angelo Gabriele Aulisa
- UOC of Traumatology, Bambino Gesù Children’s Hospital (IRCCS), Rome, Italy
- Department of Human Sciences, Society and Health, University of Cassino and Southern Lazio, Via S. Angelo in Theodice, Localita’ Folcara, Cassino, Italy
| | - Marco Giordano
- UOC of Traumatology, Bambino Gesù Children’s Hospital (IRCCS), Rome, Italy
| | - Pietro Savignoni
- UOC of Traumatology, Bambino Gesù Children’s Hospital (IRCCS), Rome, Italy
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Zayda AI, Mesregah MK, Zalalo SH, Sakr SAH. Functional and radiological outcomes after treatment of congenital pseudarthrosis of the tibia using the Ilizarov technique: a retrospective single-center study. J Orthop Traumatol 2022; 23:48. [PMID: 36149607 PMCID: PMC9508293 DOI: 10.1186/s10195-022-00667-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 09/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Congenital pseudarthrosis of the tibia (CPT) is a challenging problem in orthopedic practice, with high rates of non-union, refracture, and residual deformities. After union, long-term follow-up is required to manage late post-union complications. This study aimed to assess the outcomes of the Ilizarov technique in the management of CPT. MATERIALS AND METHODS This retrospective study included patients with CPT treated with the Ilizarov method between 2005 and 2018. Intramedullary rods were used in 9 cases and iliac bone graft was used in 12 cases. An orthosis was applied till the end of follow-up in all cases. The American Orthopaedic Foot and Ankle Society (AOFAS) scale was used for the evaluation of the functional outcomes. RESULTS This study included 16 patients, 11 males and 5 females, with an average age of 5.4 ± 2.8 years. Seven cases had multiple previous surgeries. Six patients had neurofibromatosis. The mean follow-up period was 5.8 ± 3.4 years. The average AOFAS score improved significantly from 47.5 ± 7.6 preoperatively to 78.9 ± 8.9 at the latest follow-up. Union was achieved in 15 cases, and persistent non-union occurred in one case. The clinical results were excellent in one patient, good in seven cases, fair in 6, and poor in 2 cases. The radiological results were excellent in one patient, good in seven cases, fair in seven, and poor in one case. CONCLUSIONS The Ilizarov technique combined with intramedullary rod and primary or secondary bone graft provides a high union rate of CPT and can achieve simultaneous effective management of problems related to pseudarthrosis, including non-union, deformity, limb shortening, and adjacent joint contracture and subluxation. Level of evidence Level IV.
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Affiliation(s)
- Ahmed Ibrahim Zayda
- Department of Orthopaedic Surgery, Faculty of Medicine, Menoufia University, Menoufia, Shebin-El-Kom, Egypt
| | - Mohamed Kamal Mesregah
- Department of Orthopaedic Surgery, Faculty of Medicine, Menoufia University, Menoufia, Shebin-El-Kom, Egypt.
| | - Soliman Hassan Zalalo
- Department of Orthopaedic Surgery, Faculty of Medicine, Menoufia University, Menoufia, Shebin-El-Kom, Egypt
| | - Samy Abdel-Hady Sakr
- Department of Orthopaedic Surgery, Faculty of Medicine, Menoufia University, Menoufia, Shebin-El-Kom, Egypt
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Siebert MJ, Makarewich CA. Anterolateral Tibial Bowing and Congenital Pseudoarthrosis of the Tibia: Current Concept Review and Future Directions. Curr Rev Musculoskelet Med 2022; 15:438-446. [PMID: 35841513 PMCID: PMC9789274 DOI: 10.1007/s12178-022-09779-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/30/2022] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW Congenital pseudarthrosis of the tibia (CPT) is a rare condition closely associated with neurofibromatosis type I. Affected children are born with anterolateral bowing of the tibia which progresses to pathologic fracture, pseudarthrosis, and high risk of refracture even after initial union has been attained. There is currently no consensus on the classification of this disease or consensus on its treatment. The purpose of this review is to (1) review the clinical presentation, etiology, epidemiology, classification, and natural history of congenital pseudarthrosis of the tibia and (2) review the existing trends in treatment of congenital pseudarthrosis of the tibia and its associated complications. RECENT FINDINGS Current treatment protocols focus primarily on combining intramedullary fixation with external or internal fixation to achieve union rates between 74 and 100%. Intramedullary devices should be retained as long as possible to prevent refracture. Cross-union techniques, though technically difficult, have a reported union rate of 100% and no refractures at mid- to long-term follow-up. Vascularized fibular grafting and induced membrane technique can be successful, but at the cost of numerous surgical procedures. Growth modulation is a promising new approach to preventing fracture altogether, though further study with larger patient series is necessary. The primary consideration in treatment of CPT is expected union rate and refracture risk. Combined intramedullary and external or internal fixation, especially with cross-union techniques, show most promise. Perhaps most exciting is further research on preventing fracture through guided growth, which may reduce the morbidity of multiple surgical procedures which have been the mainstay of treatment for CPT thus far.
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Affiliation(s)
- Matthew J. Siebert
- grid.223827.e0000 0001 2193 0096Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108 USA
| | - Christopher A. Makarewich
- grid.223827.e0000 0001 2193 0096Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108 USA ,grid.415178.e0000 0004 0442 6404Primary Children’s Hospital, Salt Lake City, UT USA ,grid.509583.2Shriners Children’s, Salt Lake City, Utah USA
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Khmyzov SO, Katsalap YS, Karpinsky MJ, Karpinska O. EXPERIMENTAL STUDY OF BONE DENSITY IN PATIENTS WITH CONGENITAL PSEUDOARTHROSIS OF THE TIBIA BEFORE AND AFTER SURGERY. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2022; 75:2112-2120. [PMID: 36256938 DOI: 10.36740/wlek202209112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
OBJECTIVE The aim: Determine the changes in bone density that occur in the cortical layer of the tibia in patients with CPT after surgical treatment due to radiography data. PATIENTS AND METHODS Materials and methods: The study was performed on X-rays of the tibia of three patients with CPT, aged 5 to 7 years. X-rays were taken before surgery and 1 year after surgery. The optical density of the cortical layer of both tibia bones was determined, for which they were conditionally divided into 7 zones. RESULTS Results: In all patients with CPT before treatment, there is significant decrease in the optical density of cortical bone tissue of the damaged tibia compared with contralateral. One year after surgery, there was an increase in the optical density of the cortical layer of both tibia of the studied patients. The increase in the density of the nonoperated tibia can be attributed to the active growth of patients. On the operated limb, the increase in the density of the cortical layer became statistically significant in all studied areas, which can be attributed not only to the growth of patients, but also to the possibility of active loading of the operated limb. CONCLUSION Conclusions: In all patients with CPT before treatment, a statistically significant decrease in the density of cortical bone tissue of the damaged tibia was observed. As a result of the treatment there is an approximation of the bone density of the operated limb to the indicators of intact contralateral bone.
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Affiliation(s)
- Sergiy O Khmyzov
- SYTENKO INSTITUTE OF SPINE AND JOINT PATHOLOGY, UKRAINIAN NATIONAL ACADEMY OF MEDICAL SCIENCES, KHARKIV, UKRAINE
| | - Yelyzaveta S Katsalap
- SYTENKO INSTITUTE OF SPINE AND JOINT PATHOLOGY, UKRAINIAN NATIONAL ACADEMY OF MEDICAL SCIENCES, KHARKIV, UKRAINE
| | - Mykhailo Ju Karpinsky
- SYTENKO INSTITUTE OF SPINE AND JOINT PATHOLOGY, UKRAINIAN NATIONAL ACADEMY OF MEDICAL SCIENCES, KHARKIV, UKRAINE
| | - Olena Karpinska
- SYTENKO INSTITUTE OF SPINE AND JOINT PATHOLOGY, UKRAINIAN NATIONAL ACADEMY OF MEDICAL SCIENCES, KHARKIV, UKRAINE
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