Journal
JOURNAL OF CHILDRENS ORTHOPAEDICS
Volume 2, Issue 2, Pages 133-149Publisher
BRITISH EDITORIAL SOC BONE JOINT SURGERY
DOI: 10.1007/s11832-008-0084-2
Keywords
Congenital pseudarthrosis of the tibia; Charnley-Williams intramedullary rodding; Bone transport with Ilizarov fixator; rhBMP2 treatment for CPT
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Purpose Two common treatment options for congenital pseudarthrosis of the tibia (CPT) are intramedullary fixation following resection/shortening of the pseudarthrosis site and reconstruction with an Ilizarov external fixator following resection. We present in detail a narrative of two cases with similar degrees of tibial dysplasia associated with NF-1 treated using these different methods and followed to completion. Methods Technical issues and details of the treatment methods from case reports are discussed in depth. The eventual profoundly different outcomes are correlated to the technical variations used. Results Treatment with the Charnley-Williams rodding method and aggressive bone grafting supplemented by rhBMP2 resulted in a normal functioning limb at maturity, while treatment with first, an ineffective version of IM rodding, followed by two sessions of bone transport using an Ilizarov fixator failed to gain useful union and eventually resulted in amputation. Conclusions Technical details, heretofore inadequately reviewed in the literature, are crucial to the success of either of these commonly utilized treatment methods for CPT.
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