Congenital pediatric pseudoarthrosis of the tibia is one of the rarest and most challenging conditions seen in pediatric orthopedics.
The condition results from congenital tibial dysplasia that progresses to the point where the risk of tibial fracture becomes high. Once a fracture occurs and congenital pseudoarthrosis develops, treatment options are limited and any union of the tibia going forward may be complicated by refracture, deformity, leg-length discrepancy, stiffness, pain and dysfunction.
In the hopes of addressing the above concerns, Gillette’s pediatric orthopedics team designed a novel course of treatment intending to prevent tibial dysplasia from progressing to the point of fracture in the first place.
“Unfortunately, once a pseudoarthrosis develops, getting the tibia and fibula to heal may take years, with each case presenting unique challenges,” says Gillette pediatric orthopedic surgeon Mark Dahl, MD, “The method we designed involves using a minor outpatient surgery to “guide growth” of a deformed tibia, gradually straightening the tibia, allowing it to develop more normally, and preventing early fractures that inevitably lead to pseudoarthrosis. If we prevent or at least delay early fractures, we alleviate some of the biggest concerns in terms of life-long development and functionality for the patient.”
Dr. Dahl, Jennifer Laine, MD, Andrew Georgiadis, MD and Elizabeth Weber, MD, began incorporating this treatment of tibial growth modulation with eligible patients in 2011. This resulted in a study that followed ten patients treated at Gillette between 2011 and 2017, and was published in the Journal of Bone and Joint Surgery in December of 2020.
Of the 10 patients involved in the study who received distal tibial growth modulation at Gillette, none developed tibial fracture or pseudoarthrosis after they received treatment. Additionally, the patients treated showed improved tibial alignment, improved radiographic appearance of bone quality, and preserved leg length.
“This new approach in preventing fracture for these patients is life-changing,” says Dr. Laine. “The preventative treatment decreases surgical interventions, increases the function of the leg, preserves leg length, and is a straightforward technique to addressing a rare condition. Since we published, we’ve had surgeons from around the world reaching out to us for advice on their patients. Our hope is that this study will lead to fewer fractures and an improved quality of life for these patients worldwide.”