title: Use of an intramedullary Kirschner wire for treatment of congenital pseudarthrosis of the tibia in children.
abstract: Congenital pseudarthrosis of the tibia remains one of the most difficult, challenging conditions in pediatric orthopedics. The purpose of this study was to evaluate the long-term results of a technique consisting of excision of the pseudarthrosis, autologous bone grafting, and insertion of an intramedullary Kirschner wire into the tibia. Twenty-nine consecutive patients with congenital pseudarthrosis of the tibia were treated with this technique between 1984 and 2004, and the results were retrospectively reviewed and classified into three levels: good, fair, and poor. Complications were also noted. There were 13 patients (44.8%) who had fibular pseudarthrosis. Sixteen patients (52.2%) had primary union at the site of the tibial pseudarthrosis. Refracture occurred in 17 children (58.6%). Twenty-one children (72.4%), despite healed pseudarthrosis, still had residual valgus angulation at the ankle. Twenty-two patients (75.9%) had a residual limb-length discrepancy of greater than 3 cm. At the final follow-up, there were good results in four patients (13.8%), fair results in 12 patients (41.4%), and poor results in 13 patients (44.8%). This technique produced a relatively satisfactory long-term functional outcome, and should be considered in the management of congenital pseudarthrosis of the tibia.
authors.affiliation: National Hospital of Pediatrics of Vietnam, Hanoi, Vietnam. ngocyenhung@gmail.com
authors.forename: Ngoc Hung
authors.initials: NH
authors.lastname: Nguyen
mesh_terms: D000843:Ankle Joint / Q000473:pathology; D017760:Bone Malalignment / Q000209:etiology; D001864:Bone Wires; D005260:Female; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation* / Q000379:methods; D017102:Fracture Healing; D006801:Humans; D007870:Leg Length Inequality / Q000209:etiology; D008297:Male; D011183:Postoperative Complications; D011542:Pseudarthrosis / Q000151:congenital* / Q000601:surgery*; D020127:Recovery of Function; D012008:Recurrence; D012189:Retrospective Studies; D013978:Tibial Fractures / Q000151:congenital* / Q000601:surgery*; D016896:Treatment Outcome