Anterolateral Bowing of Congenital Pseudoarthrosis of Tibia Treated by Percutaneous Osteotomy and Gradual Correction Using Taylor Spatial Frame, then Late Insertion of a Fussier-Duval Nail: A Case Report

Patient: Male, 12 Final Diagnosis: Congenital pseudoarthrosis of tibia Symptoms: Limp • deformity Medication: — Clinical Procedure: Percutaneous osteotomy and gradual correction Specialty: Orthopedics and Traumatology OBJECTIVE: Unusual or unexpected effect of treatment BACKGROUND: Congenital pseudoarthrosis of the tibia is one of the most difficult orthopedic diseases to treat. Many authors consider osteotomy of the bowed non-broken tibia a contraindication. However, leaving the patient with a deformed, bowed leg is intolerable and is associated with deformity progression and increased risk of fracture. CASE REPORT: A 12-year-old boy presented with a bowed leg. X-ray tibia showed partially healed congenital pseudoarthrosis of the tibia and 30 degrees of flexion deformity. Deformity was successfully treated by percutaneous osteotomy made through the site of congenital pseudoarthrosis and gradual correction using a computer-assisted external fixator, the Taylor spatial frame (TSF; Smith and Nephew, Memphis, TN). At the end of the correction, a telescopic Fassier-Duval intramedullary nail was used prophylactically to prevent re-fracture. After 2 years of follow-up, X-ray images show bone-healing without any bowing. CONCLUSIONS: Closed percutaneous osteotomy, without excision of the pseudoarthrosis, and gradual correction then insertion of Fassier-Duval telescopic nail may serve as a treatment to correct deformed bone in congenital pseudoarthrosis of the tibia.