MANAGEMENT OF CONGENITAL PSEUDARTHROSIS OF THE TIBIA

Abstract

Congentital pseudarthrosis of the tibia is still remains one of the most difficult conditions to treat and nonunion often persists despite prolonged immobilisation and bone grafting operations. Pseudarthrosis may be represented clinically be three forms : Either ( 1) Associated with neurofibromatosis . The tibia may be intact at birth but sh0\1; anterior angulation with segmental sclerosis in addition it may show an hourglass constriction and a small cyst. Extern51l evidence of neurofibromatosis , cafe- au - lait patches may be present .

(2) Associated with fibrous dysplasia the tibia is bowed anterior and has the charcteristic cysts of fibrous dysplasia , the cysts expand the cortex of the tibia and have dens reactive bone formation. (3) Associated with ai1terior b.owing of the tibia in these cases , the anterior bowing is smooth with no data suggesting neurofibromatosis or fibrous dyplasia , pseudarthrosis may occur following osreotomy or minor inji:u'ies. Psuedarthrrosis may be :

Mobile.

Stiff without deformity hypertrophic pseudarthrosis there is strongly resembling fibrous zone . Stiff with deformity like anterior angulation or LLD.

It is unusual to see these cases bcfon: the Ji•acturc has occurred but if the child presents with anterior bowing of the tibia with an intact fibula congenital pseudai•thrcJ'i• must be suspected . A corrective osteotomy at this stage will precipitate the onset of a pseudarthrosis.