title: Transfer of ipsilateral fibula on vascular pedicle for treatment of congenital pseudarthrosis of the tibia.
abstract: BACKGROUND
  Although the use of free vascularized fibula grafts has frequently been reported in the treatment of congenital pseudarthrosis of the tibia, the use of ipsilateral fibula graft on a vascular pedicle is uncommon. We reviewed the long-term results of this procedure in 11 patients.
  
  
  METHODS
  The records of 11 patients who underwent transfer of the ipsilateral fibula on a vascular pedicle between 2.1 and 10.8 years of age were retrospectively reviewed. Average follow-up was 11 years after the index procedure. Seven patients had reached skeletal maturity. Clinical records and radiographs were reviewed to determine patient demographics, surgical parameters, union rate, refracture rate, residual deformity, and functional outcome.
  
  
  RESULTS
  Eight patients (73%) achieved union at an average of 20.1 months. Additional bone grafting procedures were required in 4 patients with distal nonunions. There were 3 refractures (38%). Four patients eventually underwent amputation, and 1 patient had a persistent nonunion at final follow-up. Residual deformity included tibial valgus and procurvatum deformities, limb length discrepancy, and ankle valgus. Use of the ipsilateral fibula did not seem to increase the risk of ankle valgus. Functional outcomes were good in all but one patient.
  
  
  CONCLUSIONS
  Use of the ipsilateral fibula as a pedicle graft provides reasonable results in healing congenital pseudarthrosis of the tibia. Patients should be monitored for the sequelae of this condition, including nonunion, refracture, shortening, and angular deformity, and treated accordingly.
  
  
  METHODS
  Therapeutic Level IV.
authors.affiliation: Department of Orthopaedic Surgery, Alpena Regional Medical Center, Alpena, MI, USA. j_tan3@yahoo.com
authors.forename: Jane S
authors.initials: JS
authors.lastname: Tan
authors.forename: James W
authors.initials: JW
authors.lastname: Roach
authors.forename: Angela A
authors.initials: AA
authors.lastname: Wang
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D005360:Fibula / Q000637:transplantation*; D005500:Follow-Up Studies; D005599:Fractures, Ununited / Q000453:epidemiology; D006801:Humans; D008297:Male; D011542:Pseudarthrosis / Q000151:congenital / Q000601:surgery*; D012189:Retrospective Studies; D013978:Tibial Fractures / Q000151:congenital / Q000601:surgery*; D016896:Treatment Outcome