Purpose: Congenital pseudarthrosis of the tibia remains one of the most challenging problems confronting the orthopaedic surgeon. The operative results are frequently less than successful, many cases requiring several surgical procedures, and a significant number of those ultimately ending in amputation. The purpose of this study is to to assess the surgical results, complications, secondary procedures and long-term results of vascularized fibula in the treatment of congenital pseudarthrosis of the tibia.

Material and Methods: Seven patients who had congenital pseudarthrosis of the tibia were treated consecutively at our clinic between 1992 and 2000 with free vascularized fibular graft. There were four females and three males. The mean age at the time of operation averaged 6.5 years (range 1-12 years). Four left tibias and 3 right tibias were involved. Two patients had been operated before but no union was obtained. All had been treated previously with cast and braces. After wide resection of pseudarthrosis with surrounding fibrotic and thick scar tissue reconstruction was performed with free vascularized fibular graft from the contralateral leg. Stability was maintained with internal fixation in four patients, external fixation in two patients and intramedullary pin in one patient.

Results: The average follow-up was 2.6 years (range 6 months to 8 years). In five patients, both ends of the graft healed primarily within 2.7 months (range 1.5 to 3 months), and hypertrophy of the fibular graft occurred rapidly with a well-formed medullary canal. In one patient the distal junction did not unite and although required three subsequent operations still not healed. Stress fracture occurred in the middle of the grafted fibula in one patient underwent four additional operations before union achieved.

Discussion: Free vascularized fibula transplant for congenital pseudarthrosis of the tibia is a valid method of treating this complicating problem. Despiting the continuing problems and the relatively high complication rate, the ultimate results are generally good specially as compared with published series in whom conventional grafting techniques had failed. However, even achieving union of pseudarthrosis is not enough for the resolution of this disease and is only half of the problem; the other half is to maintaining it. Long-term follow-up beyond skeletal maturity if possible, is necessary to evaluate surgical results.