Vascularized Bone Graft for the Congenital Pseudoarthrosis of the Tibia.

The long term follow-up of 10 patients with congenital pseudoarthrosis of the tibia treated by vascularized bone graft are reported here. 7 patients were female, and 3 were male. All were classified initially as Boyd's Type 2 pseudoarthrosis. The age at clinical presentation ranged from birth to 6 years old. 7 patients had had 11 previous surgeries prior to vascularised bone grafting, the unions having failed, they were refered to us. The age at vascularized bone grafting ranged from 2 to 13 years. 8 patients had a vascularized fibula graft (VFG) to fill a defect ranging from 6 to 13cm in size. Two patients, one who was a first case of vascularized bone graft, and the the other who had a defect of the contralateral fibula caused by a previous surgery, had a vascularized rib hraft (VRG).All the patients except two showed a primary bone union within four months. One VFG and one VRG failed to unite at the proximal junction with the tibia. The VRG nonunion united after receiving a conventional bone graft, but the VFG one failed to unite. As the family refused any further surgery, this case was classified as a failure and continues to wear a brace. The follow-up was from 5 to 12 years. 8 spontaneous fractures were seen in 4 patients who had been succesfully treated with conventional bone grafts. Two patients received osteotomies to correct angulation deformities. The leg length discrepancy ranged from 1 to 6cm and averaged 3.8cm. Patients with VRG tended to develop angulation deformities. Inspite of several complications, vascularised fibular grafting may be the most reliable technique in achieving bone union in congenital pseudoarthrosis of the tibia.