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KMID : 0361620090440010046
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Journal of the Korean Orthopaedic Association
2009 Volume.44 No. 1 p.46 ~ p.53
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Long-term Follow-up Results of the Free Vascularized Fibular Graft in Congenital Pseudarthrosis of the Tibia
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Chung Duke-Whan
Han Chung-Soo
Hwang Jung-Chul
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Abstract
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Purpose: To report the long-term follow-up results of a free vascularized fibular graft (FVFG) for the treatment of patients with congenital pseudarthrosis of the tibia (CPT).
Materials and Methods: Fourteen patients with CPT, who underwent FVFG and were followed-up for more than 4 years, were enrolled in this study. The average age at FVFG was 4.5 years (range, 1~10.6 years) with an average follow-up of 11.6 years (range, 4~26.6 years). In 11 cases, 24 additional procedures were performed due to the secondary problems, such as delayed union, nonunion, leg length discrepancy, and deformity of the tibia. The clinical and radiological data were reviewed to evaluate the outcomes of the FVFG.
Results: Bone union and hypertrophy of the fibular graft was observed in all cases. The average time of union in 7 cases, in whom bone union was achieved without the aid of any supplementary procedures, was 6.7 months (range, 3.5~11 months). At the last follow-up, the mean limb length discrepancy was 2.5 cm (range, 0~8 cm), and the average anterior apex and valgus angulation of the tibial shaft were 18.4˚ (range, 0~85˚) and 9.9˚ (range, ?5~34˚), respectively. The mean ankle alignment was valgus 7.2˚ (range, ?3~30˚), and the mean range of motion of the ankle joint was dorsiflexion 17˚ and plantar flexion 30˚.
Conclusion: FVFG is an effective procedure in congenital pseudarthrosis of the tibia which has the advantages of allowing a more aggressive resection of the abnormal bone and scar tissue and as well as resolving the bone defect after resecting the lesion. This procedure is expected to produce a better clinical result if rigid internal and external fixation are performed.
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KEYWORD
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Tibia, Congenital pseudarthrosis, Free vascularized fibular graft
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