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Review
. 2022 Dec;15(6):438-446.
doi: 10.1007/s12178-022-09779-y. Epub 2022 Jul 16.

Anterolateral Tibial Bowing and Congenital Pseudoarthrosis of the Tibia: Current Concept Review and Future Directions

Matthew J Siebert  1 , Christopher A Makarewich  2   3   4
Affiliations
Review

Anterolateral Tibial Bowing and Congenital Pseudoarthrosis of the Tibia: Current Concept Review and Future Directions

Matthew J Siebert et al. Curr Rev Musculoskelet Med. 2022 Dec.

Abstract

Purpose of review: Congenital pseudarthrosis of the tibia (CPT) is a rare condition closely associated with neurofibromatosis type I. Affected children are born with anterolateral bowing of the tibia which progresses to pathologic fracture, pseudarthrosis, and high risk of refracture even after initial union has been attained. There is currently no consensus on the classification of this disease or consensus on its treatment. The purpose of this review is to (1) review the clinical presentation, etiology, epidemiology, classification, and natural history of congenital pseudarthrosis of the tibia and (2) review the existing trends in treatment of congenital pseudarthrosis of the tibia and its associated complications.

Recent findings: Current treatment protocols focus primarily on combining intramedullary fixation with external or internal fixation to achieve union rates between 74 and 100%. Intramedullary devices should be retained as long as possible to prevent refracture. Cross-union techniques, though technically difficult, have a reported union rate of 100% and no refractures at mid- to long-term follow-up. Vascularized fibular grafting and induced membrane technique can be successful, but at the cost of numerous surgical procedures. Growth modulation is a promising new approach to preventing fracture altogether, though further study with larger patient series is necessary. The primary consideration in treatment of CPT is expected union rate and refracture risk. Combined intramedullary and external or internal fixation, especially with cross-union techniques, show most promise. Perhaps most exciting is further research on preventing fracture through guided growth, which may reduce the morbidity of multiple surgical procedures which have been the mainstay of treatment for CPT thus far.

Keywords: Anterolateral; Bowing; Congenital pseudoarthrosis of the tibia; Tibia; Treatment.

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Conflict of interest statement

Matthew J. Siebert and Christopher A. Makarewich declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Anterior and lateral radiographic views of the tibia in a child with neurofibromatosis type 1 and anterolateral tibial bowing showing A fracture through anterior lateral tibial bow. B Reconstruction with resection of fracture/pseudoarthrosis, proximal tibia osteotomy, iliac crest bone and periosteal grafting, intramedullary and plate fixation for planned tibia and fibula cross-union. C Full healing and cross-union after reconstruction. D Rod exchange to protect area of prior fracture/pseudoarthrosis during growth
Fig. 2
Fig. 2
Distal tibia anterior lateral tension band plate hemiepiphysiodesis for anterolateral tibial bowing
See this image and copyright information in PMC

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