Nonunion/Bone Loss

Congenital Bifocal Tibial Non-Union Correction

This "birth fracture" is known as congenital pseudarthrosis of the tibia, in this case associated with neurofibromatosis. As is often the case, conventional bone graft and rodding did not provide healing.

 

Problems:	1. Diagnosis - congenital pseudarthrosis of tibia 2. Ankle stiff 3. Leg length discrepancy 6.3 cm (30%) 4. Multiple surgeries 5. Broken rod 6. Nonunion angulation 35 degrees anteromedial 7. Proximal recurvatum 25 degrees
Correction:	8. Closed distraction through nonunion site 9. Proximal lengthening 10. Foot prophylaxis
The "problem list" is a method of planning advocated by Ilizarov, and used in every case at the MLLC.

The bone was straightened through the non-union site as well as through a corticotomy in the upper tibia. Healing required eight months in the fixator. Despite remarkable healing potential with the Ilizarov method, congenital pseudarthrosis of the tibia is at risk for recurrent fracture, and is commonly further protected with a brace.

Non-Union/Bone Loss Index