Pseudoathrosis of Tibia

This is a relatively rare condition in which the parents will complain of anterior or anterolateral bending of tibia (shin bone). The bowing can become apparent around 6 months of age. It goes on progressing and then the child will present with a fracture. There are mainly two types. Dysplastic type in which there is narrowing and sclerosis and cystic type in which there are cyst like areas. It may be associated with neurofibromatosis.

Non operative management:

Before the presence of fracture or if the child is less than 2 years of age then plaster or a brace can be given to protect the limb

Operative management:

The non union site needs to be excised and an intramedullary rod is inserted to prevent refracture. Bone grafting is also required. The management of this condition is difficult and repeated surgery may be required. In older children Ilizarov method for compression and lengthening can be used to attain union. Newer elongating rods have also been used with good results.

Clinical photo showing bowing of tibia
Radiograph showing pseudoarthrosis
Clinical photo after surgery showing correction
Radiograph showing intramedullary rod