Bone transport with the lengthening through the physis in patients having congenital pseudarthrosis of tibia - short-term results

Congenital pseudarthrosis of tibia (CPT) is still a condition extremely difficult to treat in the field of paediatric orthopaedics. Ilizarov technique, free fibular bone graft, Charnley-Williams method [1] are the current treatment options achieving reasonable fusion rate. The solid bone fusion is the most difficult problem to treat. Limb length discrepancy (LLD) is one of the adjacent problems to solve, no matter what method is used to achieve bone fusion. There are three ways to address the LLD: lengthening the short bone, arresting the growth of the normal longer bone or a combination of the two procedures. The “bone transport” [2] proposed by Ilizarov combined the procedure of pseudarthrosis site compression with a simultaneous distraction at an adjacent site. The lengthening process during the bone transport may be performed by traction through a proximal tibial osteotomy or through the proximal tibial physis [3]. Chondrodiatasis is the term coined by DeBastiani et al. [3] and is reserved for the slow traction of the physis. The distraction epiphysiolysis is the term used for the process which encloses a real physis separation [4], like a Harris-Salter 1 fracture. The purpose of this paper is to present the results of bone transport with traction through the physis in a case series of patients with CPT, surgically treated in our department.