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Congenital Pseudarthrosis of the Tibia by Charles E. Johnston J Bone Joint Surg Am Volume 84(10):1799-1810 October 1, 2002 ©2002 by The Journal of Bone.

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Presentation on theme: "Congenital Pseudarthrosis of the Tibia by Charles E. Johnston J Bone Joint Surg Am Volume 84(10):1799-1810 October 1, 2002 ©2002 by The Journal of Bone."— Presentation transcript:

1 Congenital Pseudarthrosis of the Tibia by Charles E. Johnston J Bone Joint Surg Am Volume 84(10): October 1, 2002 ©2002 by The Journal of Bone and Joint Surgery, Inc.

2 Radiographic classification of congenital pseudarthrosis of the tibia described by Crawford 11,12. Charles E. Johnston II J Bone Joint Surg Am 2002;84: ©2002 by The Journal of Bone and Joint Surgery, Inc.

3 Figs. 2-A through 2-E Case 5, a boy with neurofibromatosis who presented with a Crawford type- II lesion when he was six months old. Charles E. Johnston II J Bone Joint Surg Am 2002;84: ©2002 by The Journal of Bone and Joint Surgery, Inc.

4 Nine months postoperatively, there was persistent nonunion (a grade-3 outcome). Charles E. Johnston II J Bone Joint Surg Am 2002;84: ©2002 by The Journal of Bone and Joint Surgery, Inc.

5 A type-A revision, including a more proximal tibial osteotomy to obtain sagittal alignment as well as transfixation of the ankle, was performed. Charles E. Johnston II J Bone Joint Surg Am 2002;84: ©2002 by The Journal of Bone and Joint Surgery, Inc.

6 One year later, there was radiographic evidence of union. Charles E. Johnston II J Bone Joint Surg Am 2002;84: ©2002 by The Journal of Bone and Joint Surgery, Inc.

7 Eight years following revision, the patient was fully active and asymptomatic and had no clinical deformity (a grade-1 outcome). Charles E. Johnston II J Bone Joint Surg Am 2002;84: ©2002 by The Journal of Bone and Joint Surgery, Inc.

8 Figs. 3-A through 3-E Case 10, a boy with neurofibromatosis who presented with a Crawford type-II lesion when he was two years old. Charles E. Johnston II J Bone Joint Surg Am 2002;84: ©2002 by The Journal of Bone and Joint Surgery, Inc.

9 One year later, a type-A revision was performed to replace the fibular rod, which had migrated distally, and to push the tibial rod higher into the proximal segment to hasten release of the ankle. Charles E. Johnston II J Bone Joint Surg Am 2002;84: ©2002 by The Journal of Bone and Joint Surgery, Inc.

10 Two years following revision, there was solid union and a mobile ankle. Charles E. Johnston II J Bone Joint Surg Am 2002;84: ©2002 by The Journal of Bone and Joint Surgery, Inc.

11 By the age of nine years, five years following revision, substantial ankle valgus had developed in spite of a healed and crossunited fibula. Charles E. Johnston II J Bone Joint Surg Am 2002;84: ©2002 by The Journal of Bone and Joint Surgery, Inc.

12 One year later, the ankle valgus has been corrected, but the diaphyseal valgus and recurvatum as well as the proximal lesion remained (a grade-2 outcome). Charles E. Johnston II J Bone Joint Surg Am 2002;84: ©2002 by The Journal of Bone and Joint Surgery, Inc.

13 Figs. 4-A through 4-E Case 2, a boy who presented with the insidious onset of varus deformity following trivial trauma when he was three and one-half years old. Charles E. Johnston II J Bone Joint Surg Am 2002;84: ©2002 by The Journal of Bone and Joint Surgery, Inc.

14 A type-C procedure without ankle transfixation was performed following failure of healing in a cast. Charles E. Johnston II J Bone Joint Surg Am 2002;84: ©2002 by The Journal of Bone and Joint Surgery, Inc.

15 Four months following revision, the fibular osteotomy site had not united and the tibial pseudarthrosis appeared to be more atrophic. Charles E. Johnston II J Bone Joint Surg Am 2002;84: ©2002 by The Journal of Bone and Joint Surgery, Inc.

16 Fifteen months following bone-grafting, the tibia appeared to be united but the fibular osteotomy site was ununited. Charles E. Johnston II J Bone Joint Surg Am 2002;84: ©2002 by The Journal of Bone and Joint Surgery, Inc.

17 At the age of eleven years and six months, three years after grafting, the tibia had also broken and gone on to frank pseudarthrosis. Charles E. Johnston II J Bone Joint Surg Am 2002;84: ©2002 by The Journal of Bone and Joint Surgery, Inc.

18 Figs. 5-A through 5-E Case 11, a boy with neurofibromatosis who was two and one-half years old at the time of presentation. Charles E. Johnston II J Bone Joint Surg Am 2002;84: ©2002 by The Journal of Bone and Joint Surgery, Inc.

19 Radiographs made three months following revision with the distal tibial segment fixed with an antegrade technique and two interlocking screws, one of which was placed in the epiphysis itself. Charles E. Johnston II J Bone Joint Surg Am 2002;84: ©2002 by The Journal of Bone and Joint Surgery, Inc.

20 Two years later, lateral bowing had recurred, with loss of fixation in the distal segment. Charles E. Johnston II J Bone Joint Surg Am 2002;84: ©2002 by The Journal of Bone and Joint Surgery, Inc.

21 A type-A revision was performed at the age of five years. Charles E. Johnston II J Bone Joint Surg Am 2002;84: ©2002 by The Journal of Bone and Joint Surgery, Inc.

22 Two and one-half years after revision, the patient had normal alignment and ankle motion (a grade-1 outcome). Charles E. Johnston II J Bone Joint Surg Am 2002;84: ©2002 by The Journal of Bone and Joint Surgery, Inc.


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