Treatment of rigid hypertrophic posttraumatic pseudarthrosis of the tibia in children using distraction osteogenesis.
Posttraumatic tibial pseudarthrosis is a relatively uncommon complication of tibia fractures in children. Although reported as a successful method of treating tibial nonunions in adults, distraction osteogenesis through a nonunion site via ring external fixation has not been described in children. The authors report three consecutive cases of distraction through an angulated, shortened, hypertrophic, posttraumatic nonunion to achieve successful union and concurrent correction of deformity. Distraction was carried out using a ring fixator with computer-guided correction. Union was achieved in each of the three patients with complete correction of deformity and length. Lengthening of 8 to 31 mm was achieved. The length of time in the external fixator ranged from 7 to 27 weeks. Pin tract infections developed in all patients; they were treated successfully using oral antibiotics. No deep infections or other significant complications developed. Each patient was followed up for at least 1 year.
Washington University School of Medicine, St. Louis Shriners Hospital for Children, and St. Louis Children's Hospital, St. Louis, Missouri 63131, USA. Gordone@msnotes.wustl.edu
J Eric
JE
Gordon
Mihir
M
Jani
Matthew
M
Dobbs
Scott J
SJ
Luhmann
Deborah A
DA
Szymanski
Perry L
PL
Schoenecker
D000063:Accidents, Traffic; D000293:Adolescent; D002648:Child; D016267:External Fixators; D005500:Follow-Up Studies; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D006984:Hypertrophy / Q000473:pathology / Q000601:surgery; D018889:Ilizarov Technique / Q000009:adverse effects*; D007870:Leg Length Inequality / Q000209:etiology / Q000601:surgery; D008297:Male; D019857:Osteogenesis, Distraction / Q000379:methods*; D011542:Pseudarthrosis / Q000209:etiology / Q000473:pathology* / Q000601:surgery; D011859:Radiography; D020127:Recovery of Function; D018570:Risk Assessment; D013978:Tibial Fractures / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D016896:Treatment Outcome