Orthopaedics, August 2004

"Several different approaches are currently used in the treatment of congenital pseudarthrosis of the tibia, giving testimony to the fact that none is entirely satisfactory. Transfer of a vascularized fibula has been used successfully, but fixation can be difficult, with resulting angulation or nonunion. In addition, the fibula may take a very long time to hypertrophy to a diameter that offers the strength of a tibia. External fixation, often in concert with excision of the pseudarthrosis and bone transport, has also been used successfully. This technique is difficult because of the short bone and the bulk of the hardware, and, if bone transport is used, the movement of the section through the tissues and its ultimate docking with the distal segment may not go smoothly. Some patients, after a number of unsuccessful attempts to achieve union, went on to amputation."