Pseudarthrosis of the tibia is basically a congenital problem. It is a rare pathology which is associated with neurofibromatosis type I. The natural history of the disease is extremely unfavourable and not only that if there is once a fracture occurs than there is a little or no tendency for the lesion to heal spontaneously.
Causes:
The exact cause of congenital pseudarthrosis of the tibia is not entirely clear. One theory is that after the fracture occurs, there is a lack of blood supply to the periosteum.
Investigation: Visually it can be seen on growing child.
X-Ray: X-ray of tibia will show the bony condition.
Treatment:
Treatment is mainly surgical and it aims to obtain a long term bone union, to prevent limb length discrepancies, to avoid mechanical axis deviation, soft tissue lesions, nearby joint stiffness, and pathological fracture.
The most commonly used methods of treatment are different modifications of Ilizarov’s technique, vascularised fibular grafting, bone grafting with intramedullary fixation, and Boyd’s double bone grafting etc.’
After failure of more than three operations and significant shortening of the tibia even amputation has to be considered.
Bone morphogenetic proteins (BMPs) are local bone growth and differentiation-regulating factors capable of inducing the formation of endochondral bone (19). BMPs have been shown to cause the differentiation and proliferation of mesenchymal stem cells into osteogenic cells capable of participating in bony repair and osseous regeneration.
During the first month after the operation, a minor wire-track infection was successfully can be treated with kefalexin. One month after surgery, a custom-made shoe, with a 3 cm elevation to compensate for the difference in the lengths of the lower extremities, was manufactured, and walking exercises were started under the supervision of a physiotherapist.
Physiotherapy Treatment for pseudarthrosis patient:
The Physiotherapy treatment should be planned according to patient’s condition. After the articulation of bones some manual physical therapy can be applied like- mobilization, mild stretching and strengthening.
At the two-months of visit, the patient hopefully will be able to walk and also it may be happened with a limp. According to case study there was no pain in the operated leg at a 6 years boy patient. Three months postoperatively, radiographs showed union and at four months, the Ilizarov device was removed. A custom-made orthosis may be manufactured for daytime use.
In follow-up at the patient will be able to walk, using the orthosis, without problems and the leg was pain-free.
