OUTCOMES OF FOUR IN ONE OSTEOSYNTHESIS IN THE TREATMENT OF CONGENITAL TIBIAL PSEUDARTHROSIS: A SYSTEMATIC REVIEW

Abstract

CPT has a natural history of recalcitrant nonunion, bone atrophy, progressive LLD and deformity, and persistent refracture even after surgical union. The aim of treatment for CPT is to achieve and sustain union. In addition, in the systematic management of CPT, many related deformities of length and angulation should be addressed. As a result, unless all of the patients have reached skeletal maturity, the reported refracture rate will often be lower than the actual rate. Vascularized fibular grafting, IM stabilization, external fixation with a circular frame, and amputation were the key surgical methods for treating CPT. Electric stimulation has also been studied. Although the confirmed outcomes are variable, IM rodding was an alternative treatment choice for achieving and maintaining union. Several authors have described free vascularized fibular grafting as a good choice for achieving union in patients with CPT, but it has a number of disadvantages, including nonunion, refracture, and persistent nonunion at one site of the graft end. A valgus or anterior bowing deformity of the affected tibia has been identified. In the case of CPT, amputation is an option. Its frequency varies from one series to another. The need for amputation is determined by the state of the foot, the number of operations performed, and the severity of LLD.