To evaluate the clinical effects of one-stage bone transport and two-stagewrapped bone grafting in the treatment of large bone defect after congenital tibial pseudoarthroplasty in children.

A retrospective analysis was performed on the cases of large bone defect after pseudoarthroplasty in children, who was treated with one-stage bone transport and two-stagewrapped bone grafting.One-stage tibial bone transport was performed in all cases with follow-up at every 2 weeks, the rate of lengthening of the tibia was 0.5 mm/day, and the transport speed was adjusted according to the quality of the callus.During the lengthening process, function exercises were strengthened for knee and ankle joint, and tibial lengthening fixator was used to prevent contractures.After the fracture ends of tibial pseudoarthrosis ends were aligned, the two-stage stage surgery of tibial pseudoarthrosis excision and wrapped bone grafting was performed.The external fixator was removed after initial healing of tibial pseudoarthrosis and transported segment.The length and healing time of bone transport, healing index, external fixation time and complications were recorded.SPSS20.0 was used to analyze the data.

A total of 6 patients with an average age of(7.5±3.1)years were enrolled in this study, including 4 males and 2 females.All patients were followed up satisfactorily with an average of 62 months.The total bone transport length was(6.7±2.8)cm, and the bone transport time was(138.7±58.1)days.The bone healing time was(328.7±103.4)days and the bone transport healing index was(46.7±12.8)d/cm.The duration of external fixator use was(275.0±74.3)days.3 cases(50%)had pin tract infection and were cured by oral Cefixime.The end of the intramedullary rod was detached from the plantar of the foot in 1 case(16.7%), which was solved by pushing the intramedullary rod upward to the proximal tibia by surgery.In one case(16.7%), the transported segment of tibia was healed in advance.Angulation of osteotomy segment was found in 1 case(16.7%), which was treated by adjusting external fixator.None of vascular nerve injury or osteomyelitis was observed.At the end-point follow-up, 4 cm shortening of tibia was occurred in 1 patient and less than 1 cm in other cases.During the follow up, neither further fracture of the elongated segment nor the tibial pseudo-articular segment was observed.

In children with large bone defects after congenital tibial pseudarthrosis surgery, one-stage bone transport and two-stage wrapped bone grafting is a preferable method with a high healing rate despite the high healing index and the long external fixation time.

Congenital Pseudoarthrosis of Tibia; Orthopedic Procedures/MT; Large Bone Defect; Bone Transportation; Wrapped Bone Graft