Congenital Pseudoarthrosis of the Tibia A Case Report

Congenital pseudoarthrosis of the tibia is a rare disease with reported incidence ranging from1140000 to 1250000 live birth. It is one of the most challenging problems in paediatric orthopaedics. It is characterized by segmental osseous defect resulting in deformities of tibia and spontaneous fractures which progresses to nonunion.The etiology is unknown. In 50 of the cases it is associated with neurofibromatosis .The pathologic process of the disorder is the growth of abnormal fibromatosis like tissue within the periosteum. Various modalities of treatment are available like bone grafting with intramedullary nail or rod fixation, vascularised bone grafting, illizarovs technique and rarely amputation. We report a case of 3 years old female child having congenital pseudoarthrosis of left tibia ( Boyds type 3 ) with no prior history of any surgical treatment. Introperatively, cystic lesion of left tibia was completely excised and fibular shortening with ipsilateral fibular cancellous bone grafting was done. Post operatively deformity of left leg corrected. Twelve months later radiograph showed bony union with acceptable functional out come and no refracture.Futher followup is needed and implant to be removed. It is shown that intramedullary k wire fixation with fibular shortening with fibular cancellous bone grafting could be a least expensive treatment of congenital pseudoarthosis of tibia.