Guided Growth to Treat Anterolateral Tibial Bowing Associated with Congenital Pseudarthrosis of the Tibia.
Journal
Journal of pediatric orthopedics
ISSN: 1539-2570
Titre abrégé: J Pediatr Orthop
Pays: United States
ID NLM: 8109053
Informations de publication
Date de publication:
01 Jul 2024
01 Jul 2024
Historique:
medline:
5
6
2024
pubmed:
5
6
2024
entrez:
5
6
2024
Statut:
ppublish
Résumé
Anterolateral tibial bowing associated with congenital tibial pseudarthrosis occurs often in patients with neurofibromatosis type 1 and results from the inability of the fractured bone to unite, leading to persistent nonunion, abnormal bone growth, and further bowing of the tibia. Current surgical and nonsurgical approaches demonstrate persistent nonunion or refracture, often resulting in amputation. This report describes the management of 3 patients with anterolateral tibial bowing and NF1 who underwent distal tibia-guided growth. The patients had an average age of 1.6 years at initial operation, with a total of 3 to 4 surgeries over an average of 2.1 years. The latest follow-up on all patients is included, at a mean of 5.1 years after the initial operation. All 3 patients experienced substantial functional improvement and improved alignment of the mechanical axis of the tibia. One patient has experienced refracture. Our study indicates that guided growth can serve as an additional surgical option to improve ALTB and potentially reduce the risk of fracture and pseudarthrosis by restoring normal mechanical alignment. Level-IV, Case Series.
Sections du résumé
BACKGROUND
BACKGROUND
Anterolateral tibial bowing associated with congenital tibial pseudarthrosis occurs often in patients with neurofibromatosis type 1 and results from the inability of the fractured bone to unite, leading to persistent nonunion, abnormal bone growth, and further bowing of the tibia. Current surgical and nonsurgical approaches demonstrate persistent nonunion or refracture, often resulting in amputation.
METHODS
METHODS
This report describes the management of 3 patients with anterolateral tibial bowing and NF1 who underwent distal tibia-guided growth.
RESULTS
RESULTS
The patients had an average age of 1.6 years at initial operation, with a total of 3 to 4 surgeries over an average of 2.1 years. The latest follow-up on all patients is included, at a mean of 5.1 years after the initial operation. All 3 patients experienced substantial functional improvement and improved alignment of the mechanical axis of the tibia. One patient has experienced refracture.
CONCLUSIONS
CONCLUSIONS
Our study indicates that guided growth can serve as an additional surgical option to improve ALTB and potentially reduce the risk of fracture and pseudarthrosis by restoring normal mechanical alignment.
LEVEL OF EVIDENCE
METHODS
Level-IV, Case Series.
Identifiants
pubmed: 38835290
doi: 10.1097/BPO.0000000000002683
pii: 01241398-202407000-00016
doi:
Types de publication
Journal Article
Case Reports
Langues
eng
Sous-ensembles de citation
IM
Pagination
e560-e565Informations de copyright
Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
Outside of the study, A.N.L. reports consulting activities with Orthopediatrics, Medtronic, Zimmer, and Globus. The remaining authors declare no conflicts of interest.
Références
Kesireddy N, Kheireldin RK, Lu A, et al. Current treatment of congenital pseudarthrosis of the tibia: A systematic review and meta-analysis. J Pediatr Orthop Part B. 2018;27:541–550.
Stevenson DA, Zhou H, Ashrafi S. Orthopedic manifestations of neurofibromatosis type 1. Am J Hum Genet. 2006;79:143–148.
O’Donnell C, Foster J, Mooney R, et al. Congenital pseudarthrosis of the tibia. JBJS reviews. 2017;5:e3.
Koivisto S-T, Laaksonen T, Ahola J-A, et al. Epidemiology and management of proximal tibia fractures in children and adolescents: A population-based study based on the Kids’ Fracture Tool. Acta Orthop. 2022;93:826–830.
Richards BS, Oetgen ME, Johnston CE. The use of rhBMP-2 for the treatment of congenital pseudarthrosis of the tibia. J Bone Joint Surg Am. 2010;92:177–185.
Kennedy J, O’Toole P, Baker JF, et al. Guided growth: A novel treatment for anterolateral bowing of the tibia. J Pediatr Orthop. 2017;37:e326–e328.
Masquijo JJ, Firth GB, Sepúlveda D. Failure of tension band plating: A case series. J Pediatr Orthop Part B. 2017;26:449–453.
Laine JC, Novotny SA, Weber EW, et al. Distal tibial guided growth for anterolateral bowing of the tibia: Fracture may be prevented. J Bone Joint Surg Am. 2020;102:2077–2086.
Murray HH, Lovell WW. Congenital pseudarthrosis of the tibia. A long-term follow-up study. Clinical Orthop Relat Res. 1982;166:14–20.