Congenital pseudo-arthrosis of the tibia is a congenital deformity characterized by anterior bowing of the tibia.
Anterolateral bowing: The precursor of congenital pseudoarthrosis of the tibia, present at birth, although the fractures and the ensuring pseudoarthrosis are rarely seen.
Etiology of Congenital pseudo-arthrosis
- Unknown
- Neurofibromatosis
- Fibrous dysplasia
Pathology
Failure of normal bone formation in the distal half of the tibia, resulting in segmental defect of bone, anterolateral angulation and pathological fracture
The site of pseudoarthrosis is usually surrounded by thickened periosteum and a heavy cuff of fibrous tissue.
Classification of Congenital pseudo-arthrosis of the tibia
Anderson’s Classification
- Dysplastic type
- Cystic type
- Late type
- Clubfoot type
- Angulated type
Boyd’s Classification
Types | Features |
---|---|
Type I | Anterior bowing with tibia defect |
Type II | Pseudoarthrosis with hourglass constriction |
Type III | Pseudarthrosis with a bone cyst |
Type IV | Sclerotic segment, March fracture |
Type V | Dysplastic fibula |
Type VI | Intraosseous neurofibroma |
Crawford’s Classification
Non-dysplastic type | Dysplastic type |
---|---|
1. Anterolateral bowing with increased density | 2. With the failure of tubulation |
Sclerosis of the medullary canal | 3. Cystic pre-fracture or canal enlargement from prior fracture |
May convert to dysplastic type following osteotomy | 4. Frack pseudoarthrosis with atrophy sucked candy narrowing ends |
Treatment Options
Treatment options for Congenital pseudo-arthrosis are summarized below:
- Ilizarov method
- Vascularized fibular graft
- Extending intramedullary nailing and bone grafting
- Electrical Stimulation