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J Liaquat Uni Med Health Sci. 2013; 12(2): 115-119

Management of Pseudarthrosis Tibia by Physeal Distraction with Ilizarov Ring Fixator

Mehtab A. Pirwani, M. Ayoub Laghari, Zameer Soomro, Yunis H. Soomro.


OBJECTIVE: To observe the results of chondrodiastasis / physeal distraction in the management of pseudarthrosis of tibia by Ilizarov ring fixator.
PATIENTS AND METHODS: Nine patients, seven males and two females, with congenital pseudarthrosis of tibia were treated from February2008 to April 2012. The age at the onset of Ilizarov
treatment was 10 to 12 years. Meticulous& complete resection of the sclerotic bone ends & surrounding fibrous hamartoma, and reopening of the medullary canals was done. Two navigation
wires were passed through both the malleoli. Generous autogenous bone graft was placed, harvested from the ipsilateral iliac crest. Advanced hybrid Ilizarov ring fixator was applied. Acute
compression at the pseudarthrosis site was done. One ring was applied in the proximal tibial
epiphysis. Fracture was done at proximal physeal plate by rotatory movements. Fibula attached
proximally and distally to proximal and distal rings.
Distraction was started on the 5th day at the rate of 0.5 mm/24 hours for 10 days. Later on distraction rate was accelerated to 1mm/day with a rhythm of 0.25 mm/6 hourly. Ankle deformities
were addressed accordingly.
RESULTS: Union was achieved in all the nine cases at the time of frame removal. All the other
associated deformities were addressed simultaneously while the frame was on. Leg length discrepancy was addressed by physeal distraction. Growth was not arrested in all cases after physeal distraction.
CONCLUSION: Ilizarov ring fixator remains the treatment of choice to achieve refracture free
union till 4 years in congenital pseudarthrosis of tibia, one of the most perplexing and challenging orthopedic problems. And there is no physeal arrest after physeal distraction to treat leg
length discrepancy.

Key words: Congenital pseudarthrosis of tibia,physeal distraction, Ilizarov ring fixator.

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