This 2008 narrative review by Vander Have et al examines congenital pseudarthrosis of the tibia (CPT) — a rare but formidable pediatric orthopedic problem — covering its unclear etiology, the limitations of existing classification systems, and the comparative evidence for intramedullary stabilization, free vascularized fibula grafting, Ilizarov fixation, and emerging rhBMP-2 use.
When you encounter a child with anterolateral tibial bowing, brace before fracture occurs and evaluate for NF1; once fracture and pseudarthrosis develop, the operative principle is the same regardless of radiographic type — resect all abnormal bone and periosteum, achieve stable IM fixation, and consider rhBMP-2 as an adjunct.
Counsel families from the outset that amputation is a legitimate endpoint if union fails after three surgical attempts, limb-length discrepancy exceeds 5 cm, or union has not occurred by age 6.
This 2008 narrative review by Vander Have et al examines congenital pseudarthrosis of the tibia (CPT) — a rare but formidable pediatric orthopedic problem — covering its unclear etiology, the limitations of existing classification systems, and the comparative evidence for intramedullary stabilization, free vascularized fibula grafting, Ilizarov fixation, and emerging rhBMP-2 use.
When you encounter a child with anterolateral tibial bowing, brace before fracture occurs and evaluate for NF1; once fracture and pseudarthrosis develop, the operative principle is the same regardless of radiographic type — resect all abnormal bone and periosteum, achieve stable IM fixation, and consider rhBMP-2 as an adjunct.
Counsel families from the outset that amputation is a legitimate endpoint if union fails after three surgical attempts, limb-length discrepancy exceeds 5 cm, or union has not occurred by age 6.