Pseudarthrosis of the Tibia

Abstract

Congenital pseudarthrosis of the tibia is a rare pediatric disorder that often presents with anterolateral bowing of the tibia. Tibial pseudarthrosis occurs in association with neurofibromatosis in 55% of patients, although only 6% of patients with neurofibromatosis have a pseudarthrosis. The pathology of the tissue is described as abnormal, cellular fibrovascular tissue with paucity of vascular ingrowth and is felt to be mainly a disorder of periosteum. Treatment includes fracture prevention; once fracture occurs, surgery is indicated to attempt to achieve bony union and maintain union until skeletal maturity. Principles of operative treatment include removal of the bone and periosteum at the site of the pseudarthrosis, deformity correction, bony correction, and stable fixation. These goals can be achieved with intramedullary nailing, free vascularized fibular grafts, and external ringed fixators. Amputation is an option when union hasn’t been achieved after three surgical attempts or if the leg length discrepancy is greater than 5 cm.