Four-in-one surgery for treatment of Crawford Ⅳ congenital pseudarthrosis of the tibia in children / 中华创伤骨科杂志

ABSTRACT

Objective:To explore the clinical efficacy of 4-in-1 surgery in the treatment of Crawford Ⅳ congenital pseudarthrosis of the tibia (CPT) in children.Methods:A retrospective study was conducted to analyze the clinical data of 86 patients with Crawford Ⅳ CPT who had been treated by 4-in-1 surgery at Orthopedic Department, Hunan Children's Hospital from January 2013 to December 2017. There were 47 boys and 39 girls, with an age of (40.7 ± 9.7) months at the time of surgery. Of them, 63 were complicated with type I neurofibromatosis. The 4-in-1 surgery consisted of resection of the tibial pseudarthrosis and surrounding hamartoma-like tissue, internal fixation with tibial intramedullary rod, grafting with wrapped autologous iliac bone, and Ilizarov external fixation. Their bone union, postoperative complications, and follow-up results were recorded.Results:The mean postoperative follow-up time was (80.1 ± 12.4) months for this cohort. The initial bone union rate was 96.5% (83/86), and the initial bone union time (4.8 ± 0.7) months. The last follow-up revealed 20 re-fractures, 15 cases of leg length discrepancy (longer tibia on the affected side in 5 ones and longer tibia on the healthy side in 10 ones), 10 cases of proximal tibial valgus, 12 cases of ankle valgus, 9 cases of bone bridge formation of the distal tibial epiphyseal plate, 10 cases of Ilizarov pin infection, and 2 cases of tibial osteomyelitis. Ankle stiffness occurred in 35 cases, and deviation of the tibial intramedullary rod from the center of the tibial medullary cavity in 60 cases, of which the intramedullary rod had to be removed in 20 because the rod protruded the tibial bone cortex. At the last follow-up, there were 15 cases of skeletal maturity and 71 cases of immature skeleton.Conclusions:In the treatment of Crawford Ⅳ CPT in children, the 4-in-1 surgery can lead to a high rate of initial bone union and definite primary clinical efficacy, but further improvements are necessary because postoperative complications are numerous.