title: [Congenital pseudarthrosis of lower leg treated by almost outdated method--case report].
abstract: BACKGROUND
  Congenital pseudarthrosis of tibia is a rare congenital deformity with progressive evolution. Treatment is vague and difficult, and many methods have been used--from once mandatory early amputation to contemporary operative (Ilizarov method, free microvascular fibular graft) and adjuvant methods (electrostimulation, biphosphonates, bone morphogenetic protein). We present the usage of once popular method of homologous graft insertion and intramedullary fixation.
  
  
  METHODS
  This is a case report of male patient with pseudarthrosis involving both crural bones (Boyd type 5), diagnosed in neonatal age. Early conservative treatment was unsuccessful, so child never initiated gait. At the age of three and a half years, operative treatment was applied: resection of pseudarthrosis on both tibia and fibula, and osteoplasty of tibia using cylindric homologous graft and intramedullary fixation with transtarsal Steinman pin, followed by long leg cast immobilization. Pin was removed after ten months, and physical therapy was initiated 1.5 year after surgery, with initial to partial weight bearing and short leg cast throughout another year. Two and a half years after surgery complete union of graft was documented, and then full weight bearing was allowed. At final visit, five years and three months after surgery, shin axis was correct, leg lengths were equal, and child had normal walk with full range of motion. X-ray showed complete union of both tibia and fibula.
  
  
  CONCLUSIONS
  Despite bad prognostic factors (young age, severe deformity), utilization of obsolete and almost forgotten treatment methods can provide excellent result.
authors.forename: Zoran
authors.initials: Z
authors.lastname: Vukasinović
authors.forename: Dusko
authors.initials: D
authors.lastname: Spasovski
authors.forename: Igor
authors.initials: I
authors.lastname: Seslija
authors.forename: Ismet
authors.initials: I
authors.lastname: Gavrankapetanović
authors.forename: Elvir
authors.initials: E
authors.lastname: Bazdar
authors.forename: Zorica
authors.initials: Z
authors.lastname: Zivković
mesh_terms: D016025:Bone Transplantation / Q000379:methods*; D002675:Child, Preschool; D005360:Fibula / Q000601:surgery*; D005594:Fracture Fixation, Intramedullary / Q000379:methods*; D006801:Humans; D007866:Leg; D008297:Male; D011542:Pseudarthrosis / Q000151:congenital* / Q000601:surgery; D019651:Plastic Surgery Procedures; D013977:Tibia / Q000601:surgery*