Treatment of congenitalTreatment of congenital
pseudarthrosis of the tibia bypseudarthrosis of the tibia by
a vascularised fibular grafta vascularised fibular graft
Poul,J ., Veselý, J*. , Bajerová J.Poul,J ., Veselý, J*. , Bajerová J.
Pediatric Surgery and Orthopaedics,Pediatric Surgery and Orthopaedics,
Brno Czech republicBrno Czech republic
*Plastic surgery, Brno*Plastic surgery, Brno
Treatment is based on this principles :Treatment is based on this principles :
1. Resection of the pseudoarthrosis over the1. Resection of the pseudoarthrosis over the1. Resection of the pseudoarthrosis over the1. Resection of the pseudoarthrosis over the
margins of the healthy and bleeding tissue.margins of the healthy and bleeding tissue.
2. Over2. Over--bridging of the bonebridging of the bone--defect by adefect by a
transplantated fibular graft on the vasculartransplantated fibular graft on the vascular
pedicle.pedicle.
3. Mikroanastomosis of the artery and vein.3. Mikroanastomosis of the artery and vein.
No 1 additional spongioplasty at the proximal pole of the graft was necessary 6 yrsNo 1 additional spongioplasty at the proximal pole of the graft was necessary 6 yrs
No 2 Multiple cystic lesions, anterolateral bowing and finally fracture developed,No 2 Multiple cystic lesions, anterolateral bowing and finally fracture developed,
additional spongioplasty was necessary 6 yrsadditional spongioplasty was necessary 6 yrs
No 2No 2 TheThe samesame patientpatient.. IncorporationIncorporation ofof thethe graftgraft andand itsits gradualgradual thickeningthickening isis
apparentapparent
66 yrsyrs
No 3 SevereNo 3 Severe deficiencydeficiency ofof bonebone tissuetissue afterafter repeatedrepeated operationsoperations.. VascularisedVascularised
graftgraft healedhealed in,in, howeverhowever distaldistal tibialtibial physisphysis waswas alreadyalready lostlost .10.10 yrsyrs
No 4No 4 RoutineRoutine methodmethod andand coursecourse ofof treatmenttreatment.. PostoperativePostoperative angiographyangiography showedshowed
primaryprimary vascularisationvascularisation ofof thethe graftgraft.. GradualGradual thickeningthickening ofof thethe graftgraft isis apparentapparent,,
thethe growthgrowth deformitydeformity ofof distaldistal tibiatibia isis apparentapparent. 3. 3 yrsyrs
No 5 Last patient, short follow up, rapid incorporation of the graft 2 yrs.No 5 Last patient, short follow up, rapid incorporation of the graft 2 yrs.
StructureStructure ofof thethe followedfollowed cohortcohort
Crawford type IV in 4 out from 5 pts.Crawford type IV in 4 out from 5 pts.
Periheral neurofibromatosis in 4 from 5.Periheral neurofibromatosis in 4 from 5.
Age at OP 2y+8MAge at OP 2y+8M -- 8y.+10M8y.+10MAge at OP 2y+8MAge at OP 2y+8M -- 8y.+10M8y.+10M
Male 3 times, female 2 timesMale 3 times, female 2 times
Duration of OP 130Duration of OP 130--200 minutes200 minutes
Additional spongioplasty in 2 from 5 pts.Additional spongioplasty in 2 from 5 pts.
Duration of the treatment concerning fullDuration of the treatment concerning full
incorporation of the graft 6Mincorporation of the graft 6M--21 M21 M
Resulting LL difference 10Resulting LL difference 10--90 mm90 mmResulting LL difference 10Resulting LL difference 10--90 mm90 mm
Duration of the followDuration of the follow--up 3up 3--10 years10 years
Thanks for Your interest for this paperThanks for Your interest for this paper