Advancing care for congenital pseudoarthrosis: A case series highlighting the combined use of an intramedullary device with either Ilizarov’s fixators or plating for the treatment of congenital pseudoarthrosis

Congenital pseudarthrosis of the tibia (CPT) is a bone defect in which non-union occurs in a dysplastic segment of the tibial diaphysis following a fracture at the same site. Once a fracture occurs through a susceptible bone and pseudoarthrosis is formed, spontaneous healing is unexpected. Therefore, surgical intervention is essential for healing. This study aimed to compare the outcomes of using intramedullary nailing with either Ilizarove’s fixator or plating as a treatment method for CPT to other treatment methods described in the literature. This case series study included nine patients who presented to the Pediatric Orthopedic clinic with CPT from 2018 to 2021. All patients were previously diagnosed with Neurofibromatosis-1 by pediatric genetics and presented with unilateral CPT. The minimum follow-up duration was 12 months. Nine patients were diagnosed with neurofibromatosis. Of the nine patients, fixation was supplemented with an Ilizarov external fixator in 5 patients, and the plate was used in 4 patients. Most patients (88.9%) achieved union, except for one patient with an infection requiring multiple surgical debridement. The type of fixation was not significantly associated with the union rate. In conclusion, patients who underwent intramedullary nailing in conjugation with Ilizarov’s fixator or plating for the treatment of CPT and cross-union have achieved excellent union rates with no refracture in early outcomes.