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Physeal and Subphyseal Distraction Osteogenesis in Atrophic-type Congenital Pseudarthrosis of the Tibia

Efficacy and Safety

Jang, Woo Young MD*; Choi, Yoon Hyo MD; Park, Moon Seok MD; Yoo, Won Joon MD§; Cho, Tae-Joon MD§; Choi, In Ho MD§

Journal of Pediatric Orthopaedics: September 2019 - Volume 39 - Issue 8 - p 422–428
doi: 10.1097/BPO.0000000000000979
Tibia
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Purpose: To examine the efficacy, safety, and clinical outcomes of distraction osteogenesis through the physis (PDO) or through subphyseal osteotomy (SPDO) in patients with atrophic-type congenital pseudarthrosis of tibia with proximal tibial dysplasia.

Methods: To validate the efficacy and safety of PDO and SPDO, radiographic and clinical parameters were compared between 5 patients who underwent proximal tibial metaphyseal or metadiaphyseal lengthening as a control (group 1) and 7 patients who underwent PDO or SPDO (group 2). Postoperative complication was also compared between the groups.

Results: A significant difference in terms of healing index (group 1, 83.3±24.7 d/cm; group 2, 35.0±11.1 d/cm; P=0.001) and percentage increase (11.0%±3.7% vs. 23.1%±10.5%, P=0.034) was observed between the 2 groups. According to the Paley classification, group 1 included 1 “problems” case and 3 “obstacles” cases, whereas group 2 included 2 “problems” cases and 1 “obstacles” case. According to the Lascombes classification, group 1 included 2 grade IIIb cases and 3 grade IV cases, whereas group 2 included 6 grade I cases and 1 grade IIa case. Severe complications were significantly higher in group 1 compared with the group 2 (P=0.007).

Conclusions: This study demonstrated that PDO or SPDO can be effectively and safely performed for tibial lengthening in atrophic-type congenital pseudarthrosis of tibia patients with proximal tibial dysplasia.

Level of Evidence: Level III.

*Department of Orthopaedic Surgery, Korea University Anam Hospital

Department of Orthopaedic Surgery, Seoul National University Hospital

§Division of Pediatric Orthopaedics, Seoul National University Children’s Hospital, Seoul

Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea

This study was conducted at Division of Pediatric Orthopaedics, Seoul National University Children’s Hospital, Seoul, Republic of Korea.

The authors have no funding source to disclose.

The authors declare no conflicts of interest.

Reprints: In Ho Choi, MD, Division of Pediatric Orthopaedics, Seoul National University Children’s Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea. E-mail: inhoc@snu.ac.kr.

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