دورية أكاديمية
أعرض في EDS

Does An Osteotomy Performed in Congenital Pseudarthrosis of the Tibia Heal?

التفاصيل البيبلوغرافية
العنوان: Does An Osteotomy Performed in Congenital Pseudarthrosis of the Tibia Heal?
المؤلفون: Nahm NJ; International Center for Limb Lengthening, Rubin Institute for Advanced Orthopaedics, Sinai Hospital of Baltimore, Baltimore, MD., Makarewich CA, Rosenwasser KA, Herzenberg JE, McClure PK
المصدر: Journal of pediatric orthopedics [J Pediatr Orthop] 2022 Jul 01; Vol. 42 (6), pp. e630-e635. Date of Electronic Publication: 2022 Mar 29.
نوع المنشور: Journal Article
اللغة: English
بيانات الدورية: Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 8109053 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1539-2570 (Electronic) Linking ISSN: 02716798 NLM ISO Abbreviation: J Pediatr Orthop Subsets: MEDLINE
أسماء مطبوعة: Publication: 2000- : Philadelphia : Lippincott Williams & Wilkins
Original Publication: New York Ny : Raven Press
مواضيع طبية MeSH: Fracture Fixation, Intramedullary* , Pseudarthrosis*/congenital , Pseudarthrosis*/surgery, Humans ; Osteotomy ; Retrospective Studies ; Tibia/surgery ; Treatment Outcome
مستخلص: Background: Shortening and deformity of the tibia commonly occur during the treatment of congenital pseudarthrosis of the tibia (CPT). The role of osteotomies in lengthening and deformity correction remains controversial in CPT. This study evaluates the approach to and outcome after osteotomy performed in CPT.
Methods: We performed an IRB approved retrospective review of consecutive patients with CPT treated at our institution from 2010 through 2019. Patients who underwent osteotomies were included in this study.
Results: Nine patients (10 osteotomies-5 proximal metaphyseal and 5 diaphyseal) with a median age at osteotomy of 8.9 years (range: 4 to 21 y) were included. Six patients had neurofibromatosis-1, 1 had cleidocranial dysplasia, and 2 patients had idiopathic CPT. Four osteotomies were performed for deformity correction, 3 osteotomies to allow intramedullary instrumentation, and 3 osteotomies for lengthening. Five osteotomies were preceded by zolendronate treatment before surgery. Nine were fixed with a rod supplemented with external fixation (7) or locking plates (2). One osteotomy was stabilized with locked intramedullary nailing alone. Four osteotomies were supplemented with autologous bone graft, and bone morphogenic protein-2 was utilized in 3 osteotomies. Median time to healing was 222.5 days (range: 124 to 323 d). One osteotomy (locked intramedullary nailing) required grafting at 5.5 months and then healed uneventfully. Median healing index for patients undergoing lengthening was 57.9 days/cm (range: 35 to 81 d/cm). All 3 osteotomies performed for lengthening required a second osteotomy for preconsolidation at a mean of 34 days. Other complications included compartment syndrome requiring fasciotomy (n=2), tibial osteomyelitis (n=1), and fracture distal to cross-union (n=1).
Conclusions: Contrary to much of the established practice, osteotomies may be safely performed in CPT for various indications. All osteotomies healed with only 1 osteotomy requiring secondary bone grafting. Although time to healing of the osteotomy was generally prolonged, this study suggests, somewhat surprisingly, that preconsolidation can occur frequently in lengthening procedures.
Level of Evidence: Level IV-case series.
Competing Interests: J.E.H. is a clinical advisor for Bonus BioGroup and a consultant for NuVasive Specialized Orthopedics, Orthofix, OrthoPediatrics, OrthoSpin, Smith & Nephew, and WishBone Medical. P.K.M. is a consultant for DePuy Synthes Companies, Novadip, Orthofix, and Smith & Nephew. The remaining authors declare no conflicts of interest.
(Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)
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SCR Disease Name: Congenital pseudoarthrosis
تواريخ الأحداث: Date Created: 20220329 Date Completed: 20220608 Latest Revision: 20230829
رمز التحديث: 20240628
DOI: 10.1097/BPO.0000000000002148
PMID: 35348473
قاعدة البيانات: MEDLINE
الوصف
تدمد:1539-2570
DOI:10.1097/BPO.0000000000002148