Quantitative Computed Tomography Assessment of Bone Deficits in Ambulatory Children and Adolescents with Spina Bifida: Importance of Puberty.

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Abstract

17. J Orthop. 2019 Nov 12;19:189-193. doi: 10.1016/j.jor.2019.11.017. eCollection 2020 May-Jun. Combined technique with hydroxyapatite coated intramedullary nails in treatment of anterolateral bowing of congenital pseudarthrosis of tibia. Popkov D(1), Popkov A(1), Dučić S(2), Lazović M(2), Lascombes P(3). Author information: (1)Clinic of Neuroorthopaedics and Systemic Diseases of the Russian Ilizarov Scientific Centre for Restorative Traumatology and Orthopaedics, 6, M. Ulyanova Street, 640014, Kurgan, Russian Federation. (2)Orthopaedic Department, Children's University Hospital, Tiršova 10, Belgrade, Serbia. (3)Division of Paediatric Orthopaedics, Hôpitaux Universitaires de Genève, Rue Willy Donzé 6, CH - 1211, Geneva, 14, Switzerland. PURPOSE: The goal of this study is to evaluate the treatment outcomes of anterolateral bowing and residual deformities of distal tibia in patients with CPT using circular external fixation and hydroxyapatite coated flexible intramedullary nailing without excision of affected part of tibia. PATIENTS AND METHODS: Six patients (4 boys and 2 girls, mean age 12.4 ± 4.1 years) were included in the study. Mean follow-up is 2.1 years. In 4 patients with early onset of disease initial surgical treatment (at age of 5-8 years) was dysplastic zone or pseudarthrosis resection with proximal metaphyseal osteotomy for bone transport. Children with unbroken bowed tibia (2 cases of type II according to Crawford classification) had no previous surgery. Neurofibromatosis type I was diagnosed in 4 cases. Surgical technique for residual deformity correction consisted of percutaneous osteotomy, application of circular external frame and composite hydroxyapatite-coated intramedullary nailing. RESULTS: Mean external fixation time was 95.3 ± 17.5 days. All patients never get fractured after frame removal. At the present time, they are considered to be healed, in 2.1 years, in average, without fractures or deformity recurrence. Mean lower limb length discrepancy varied from 2 to 10 mm at the latest follow-up control. After realignment procedure, patients didn't require additional surgery but one. Intramedullary nails were removed in two years after deformity correction for individual reason. CONCLUSION: Correction of anterolateral bowing or residual deformity in children with CPT is indicated. Association of external fixation with intramedullary nailing/rodding left in situ after frame removal ensure stability and accuracy of deformity correction. Biological methods of stimulation of bone formation in dysplastic zone are obligatory to ensure bone union. Intramedullary nailing with composite hydroxyapatite-coated surface provides mechanical and biological advantages in patients with CPT. © 2019 Professor P K Surendran Memorial Education Foundation. Published by Elsevier B.V. All rights reserved. DOI: 10.1016/j.jor.2019.11.017 PMCID: PMC6997496