Residual Nonunion in a Case of Two and-a-half Year Old Child Congenital Pseudarthrosis of Ipsilateral Tibia and Fibula Treated by Intramedullary Fixation with K-Wire and Allogenic Cancellous Strut Graft: A Case Report

Abstract

The pseudarthrosis usually develops during the first two years of life; however, there are reports of cases in which fractures developed before birth and reports of late-onset pseudarthrosis . There is a strong association between congenital pseudarthrosis (CPT) and Type I neurofibromatosis. CPT develops in about 5.7% of patients with NF-I and 40% of patients with pseudarthrosis were found to have NF-I. Main pathology is hyperplasia of fibroblasts with the formation of dense fibrous tissue at fracture site causing osteolysis, and persistence of pseudarthrosis. The difficulty in treating this condition occurs because of two factors: (i) Biologic: Poor healing ability of the dysplastic segment of bone and (ii) Mechanical: Technical difficulty to fix small and osteopenic bone fragments in children without damaging the distal physis. A multitude of treatment protocols focusing on stimulating the healing process by using different bone grafting techniques were documented. The graft materials most commonly used included osteoperiosteal graft, massive onlay graft, autogenous iliac crest bone graft, and vascularized bone graft.