Treatment Approaches for Congenital Pseudarthrosis of Tibia: Results of the EPOS Multicenter Study

TLDR

The study aimed to evaluate the therapeutic approaches employed by European Paediatric Orthopaedic Society members for congenital pseudarthrosis of the tibia. Data from 340 patients undergoing 1,287 procedures across 13 countries were analyzed. The analysis showed that effective treatment must resect the pseudarthrosis to achieve stability, correct length and axial deformities, and resolve associated issues, with the Ilizarov technique yielding the highest fusion rate (75.5%) and deformity correction, and consensus that surgery should be delayed until after age three.

Abstract

This study was designed to analyze the different therapeutic methods used by European Paediatric Orthopaedic Society members from 13 countries for congenital pseudarthrosis of tibia. The treatment data of 340 patients who underwent 1287 procedures for this condition were analyzed. The essential findings were that the method of choice needed to approach the biological problem with the aims of: (1) resecting the pseudarthrosis to provide stability, the basic requirement for bony consolidation; (2) correcting length discrepancy and axial deformity; (3) achieving fusion; and (4) solving the additional problems around the main deformity such as alignment, leg length discrepancy and ankle valgus. The Ilizarov technique emerged as being the optimal method, having the highest rate of fusion (75.5%) of pseudarthrosis and rate of success in correction of the additional deformities. There was also consensus that surgery should be avoided before the third year of life.