Prophylactic Bypass Grafting and Long-Term Bracing in the Management of Anterolateral Bowing of the Tibia and Neurofibromatosis- 1

Ofluoglu, Onder; Davidson, Richard S.; Dormans, John P.
October 2008
Journal of Bone & Joint Surgery, American Volume;Oct2008, Vol. 90-A Issue 10, p2126
Academic Journal
Background: Congenital anterolateral bowing of the tibia is a pre-pseudarthrosis stage of congenital pseudarthrosis of the tibia and is associated with a substantial risk of fracture and pseudarthrosis. We evaluated the results of prophylactic bypass grafting performed in combination with bracing to prevent fracture and pseudarthrosis. Methods: This retrospective series included ten patients with pre-pseudarthrosis of the tibia treated, between 1991 and 2002, with prophylactic bypass grafting with an allograft fibula placed posteromedially in a stress-bearing fashion. The average patientagewas 2.3 years at the time of diagnosis, 3.6 years at the time of surgery, and ten years at the time of final follow-up. The mean duration of follow-up was seventy-eight months. Brace protection was recommended at the time of diagnosis and was continued after the operation until maturity. Despite the bracing, a low-energy fracture developed and partially healed priorto the bypass grafting in one patient. The remaining nine patients had no fractures prior to the bypass grafting. At the time of final follow-up, the patients were examined clinically and radiographically for the presence of a fracture or pseudarthrosis and for residual deformity, including malalignment, ankle and knee joint abnormalities, and leg length discrepancy. Results: No patient had either a fracture or a pseudarthrosis of the tibia at the time of follow-up. All grafts united to the tibia at both ends. Complications included an allograft fracture in three patients, which healed in all; allograft resorption in one patient; and pseudarthrosis of the ipsilateral host fibula in one patient. At the time of final follow-up, a mean of 9 mm (range, 0 to 37 mm) of leg length discrepancy was found. A corrective osteotomy was done for four patients (three because of ankle valgus and one because of diaphyseal deformity). Conclusions: In this small series of ten patients with congenital anterolateral bowing of the tibia treated with bypass strut grafting and long-term bracing, there were no cases of pseudarthrosis of the tibia. Distal tibial deformity may persist throughout the growth period and require operative correction in patients treated with this procedure. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.


Related Articles

  • Distal Tibiofibular. Bone-Bridging in Transtibial Amputation. Pinzur, Michael S.; Beck, Jennifer; Himes, Ryan; Callaci, John // Journal of Bone & Joint Surgery, American Volume;Dec2008, Vol. 90-A Issue 12, p2682 

    Background: The creation of a bone bridge between the residual tibia and fibula is a controversial surgical technique used in the performance of transtibial amputation. Methods: Twenty consecutive patients who underwent a unilateral transtibial amputation, as a consequence of traumatic injury,...

  • Posterior Short-Segment Fixation with or without Fusion for Thoracolumbar Burst Fractures. Li-Yang Dai; Lei-Sheng Jiang; Sheng-Dan Jiang // Journal of Bone & Joint Surgery, American Volume;May2009, Vol. 91-A Issue 5, p1033 

    Background: The impact of fusion as a supplement to short-segment instrumentation for the treatment of thoracolumbar burst fractures is unclear. We conducted a controlled clinical trial to define the effect of fusion on lumbar spine and patient-related functional outcomes. Methods: From 2000 to...

  • Outcomes of Calvarial Bone Grafting for Alveolar Ridge Reconstruction. Rajesh Gutta; Waite, Peter D. // International Journal of Oral & Maxillofacial Implants;2009, Vol. 24 Issue 1, p131 

    Purpose: This article describes a series of patients who underwent calvarial bone grafting (CBG) for reconstruction of extremely edentulous jaws for the purpose of implant placement. Materials and Methods: A retrospective review was conducted of all patients treated with split CBGs to the...

  • Defectos óseos en artroplastia de revisión de rodilla tratados con aloinjerto óseo y plasma rico en plaquetas. Macule-Beneyto, Francisco; Segur-Vilalta, Josep; Vilchez-Cavazos, Felix; Esteban-Navarro, Pedro; Vidal-Sicart, Sergi; Acosta-Olivo, Carlos // Cirugia y Cirujanos;jul/ago2014, Vol. 82 Issue 4, p395 

    Background: One of the most challenging aspects of a revision knee arthroplasty is the management of bone loss. The objective of the study is to show the capability to augment bone mineral density in areas with bone loss with platelet-derived growth factors. Methods: Randomized, prospective,...

  • Utilidad del aloinjerto óseo estructurado para defectos acetabulares en prótesis de revisión. García-Anaya, L. E.; Negrete-Corona, J.; Jiménez-Aquino, J. M. // Acta Ortopedica Mexicana;Jul/Aug2014, Vol. 28 Issue 4, p212 

    Introduction: Coxarthrosis is considered as an increasingly frequent condition that will lead to an important demand for primary total hip arthroplasty in the coming decades and this, in turn, will increase the number of revision hip arthroplasties. The most common indications for revision are...

  • Criocirugía adyuvante en el tratamiento del quiste óseo unicameral. Tena-Sanabria, Mario Edgar; de Jesús Hernández-Hernández, Melissa; Tena-González, Mario Edgar; Mejía-Aranguré, Juan Manuel // Revista Medica del IMSS;2014 Supplement 2, Vol. 52, pS78 

    Background: Multiple treatments have been used for the unicameral bone cyst lesion, such as steroid application, multiple perforations, bone curettages, partial resection and bone grafting. The purpose of this study was to describe the evolution of children with unicameral bone cyst who were...

  • PERSPECTIVE. Barber, F. Alan // Orthopedics Today;Jul2011, Vol. 31 Issue 7, p55 

    The author presents his views on Daniel Hampton's study which investigated the influence of donor age on clinical outcomes in cases of anterior cruciate ligament (ACL) reconstruction with patellar tendon allograft.

  • Clinical digest. Trial proves apremilast is effective long-term treatment for psoriasis.  // Nursing Standard;10/10/2012, Vol. 27 Issue 6, p14 

    The article discusses research in the article "Efficacy of Apremilast in the Treatment of Moderate to Severe Psoriasis: A Randomised Controlled Trial" by K. Papp et al. which found that the drug apremilast is effective for the long term treatment of psoriasis.

  • Clinical digest. Evidence supports wider use of tranexamic acid in traumatic bleeding.  // Nursing Standard;10/10/2012, Vol. 27 Issue 6, p15 

    The article discusses research in the article "Effect of Tranexamic Acid on Mortality in Patients With Traumatic Bleeding: Prespecified Analysis of Data From Randomised Controlled Trial" by I. Roberts et al. which found that tranexamic acid is safe and effective in treating traumatic bleeding.


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics