Email this article Reconstructive surgery in the treatment of congenital pseudarthrosis of the tibia in children using microsurgical techniques: Reconstruction or amputation?
- Authors: Zakharyan E.A.1, Chigvariya N.G.1,2, Garkavenko Y.E.1,2, Pozdeev A.P.1,2, Grankin D.Y.1, Afonichev K.A.1,2
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Affiliations:
- H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery
- North-Western State Medical University named after I.I. Mechnikov
- Issue: Vol 10, No 4 (2022)
- Pages: 429-439
- Section: Exchange of experience
- URL: https://journals.rcsi.science/turner/article/view/264657
- DOI: https://doi.org/10.17816/PTORS110805
- ID: 264657
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Abstract
BACKGROUND: Numerous methods are available for the treatment of congenital pseudarthrosis of the tibia, but none of them offers a 100% satisfactory result and does not exclude the development of repeated refractories. One of the treatment methods is vascularized transplantation of a fragment of the fibula into the position of the defect of the tibia. However, the achievement of consolidation of the bone fragments of the lower leg does not stop the series of interventions necessary to restore the function of the affected segment. Therefore, specialists were asked about the advisability of performing amputations as an alternative to long-term and multistage interventions.
AIM: To analyze the results of the use of microsurgical techniques for the treatment of patients with congenital pseudarthrosis of the tibia and, using the example of a patient, to show the way of multistage reconstruction of the lower limb.
MATERIALS AND METHODS: The results of the use of microsurgical techniques in the elimination of a defect in the bones of the leg in five patients with congenital pseudarthrosis of the tibia were analyzed. Age, sex, presence of type 1 neurofibromatosis, bone defect size, autograft size, duration of consolidation, osteosynthesis index, refractory, range of joint motion, and secondary deformities of the segments after consolidation were assessed. The course of the patient when performing severe reconstructive interventions to restore the weight-bearing capacity of the limb was described. Vascularized autograft transplantation was performed by a qualified microsurgical team.
RESULTS: The mean age was 7.8 ± 2.2 years. Boys predominated, and type 1 neurofibromatosis was detected in 60% of the cases. The average defect size was 8.8 ± 1.6 cm, and the autograft size was 10.8 ± 1.6 cm. The duration of fixation was 260 ± 90 days, and the fixation index was 24.6 ± 10.6 days/cm. In two cases, 1 year after the fibula transfer, refractories were noted at the bone–graft interface. In 100% of the cases, patients had fibrous ankylosis at the level of the ankle joint, with a loss of functional range of motion, and in 40% of cases, there were flexion–extension contractures of the knee joints with an extension deficit of up to 20°. For this observation period, 3 of 5 patients underwent additional surgical interventions to correct the deformities of the affected limb.
CONCLUSIONS: The use of VFT in patients with congenital pseudarthrosis of the tibia allows restoring the integrity of the tibia. Multiple interventions performed on the same segment can lead to irreversible secondary changes in adjacent joints and loss of function of this limb.
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##article.viewOnOriginalSite##About the authors
Ekaterina A. Zakharyan
H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery
Author for correspondence.
Email: zax-2008@mail.ru
ORCID iD: 0000-0001-6544-1657
SPIN-code: 4851-9908
MD, PhD, Cand. Sci. (Med.)
Russian Federation, Saint PetersburgNikolay G. Chigvariya
H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery; North-Western State Medical University named after I.I. Mechnikov
Email: chigvariya72@mail.ru
ORCID iD: 0000-0003-4842-7639
SPIN-code: 4042-7092
MD, PhD, Cand. Sci. (Med.)
Russian Federation, Saint Petersburg; Saint PetersburgYuriy E. Garkavenko
H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery; North-Western State Medical University named after I.I. Mechnikov
Email: yurigarkavenko@mail.ru
ORCID iD: 0000-0001-9661-8718
SPIN-code: 7546-3080
Scopus Author ID: 57193271892
MD, PhD, Dr. Sci. (Med.)
Russian Federation, Saint Petersburg; Saint PetersburgAlexander P. Pozdeev
H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery; North-Western State Medical University named after I.I. Mechnikov
Email: prof.pozdeev@mail.ru
ORCID iD: 0000-0001-5665-6111
SPIN-code: 3408-8570
Scopus Author ID: 6701438186
ResearcherId: T-6146-2018
MD, PhD, Dr. Sci. (Med.), Professor
Russian Federation, Saint Petersburg; Saint PetersburgDenis Y. Grankin
H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery
Email: grankin.md@gmail.com
ORCID iD: 0000-0001-8948-9225
MD, Research Associate
Russian Federation, Saint PetersburgKonstantin A. Afonichev
H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery; North-Western State Medical University named after I.I. Mechnikov
Email: afonichev@list.ru
ORCID iD: 0000-0002-6460-2567
SPIN-code: 5965-6506
MD, PhD, Dr. Sci. (Med.)
Russian Federation, Saint Petersburg; Saint PetersburgReferences
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