Use of an intramedullary Kirschner wire for treatment of congenital pseudarthrosis of the tibia in children

Abstract

Congenital pseudarthrosis of the tibia remains one of the most difficult, challenging conditions in pediatric orthopedics. The purpose of this study was to evaluate the long-term results of a technique consisting of excision of the pseudarthrosis, autologous bone grafting, and insertion of an intramedullary Kirschner wire into the tibia. Twenty-nine consecutive patients with congenital pseudarthrosis of the tibia were treated with this technique between 1984 and 2004, and the results were retrospectively reviewed and classified into three levels: good, fair, and poor. Complications were also noted. There were 13 patients (44.8%) who had fibular pseudarthrosis. Sixteen patients (52.2%) had primary union at the site of the tibial pseudarthrosis. Refracture occurred in 17 children (58.6%). Twenty-one children (72.4%), despite healed pseudarthrosis, still had residual valgus angulation at the ankle. Twenty-two patients (75.9%) had a residual limb-length discrepancy of greater than 3 cm. At the final follow-up, there were good results in four patients (13.8%), fair results in 12 patients (41.4%), and poor results in 13 patients (44.8%). This technique produced a relatively satisfactory long-term functional outcome, and should be considered in the management of congenital pseudarthrosis of the tibia.