Congenital Pre-Pseudarthrosis of the Tibia: A 9-Year Follow-Up Case Report.
- 1Department of Physiotherapy, College of Health Sciences, Hawler Medical University, Erbil, Kurdistan Region, Iraq.
- 2Department of Surgery, Faculty of General Medicine, Koya University, Koya, Kurdistan Region, Iraq.
Abstract
Congenital tibial pre-pseudarthrosis is the intact dysplastic stage of the congenital pseudarthrosis spectrum. Management before fracture is unsettled: Bracing is commonly used, whereas prophylactic surgery is reserved for selected circumstances. A 2-year-and-2-month-old boy had painless anterolateral bowing and dysplastic narrowing of the left tibia without pathological fracture or established pseudarthrosis. Bracing was continued for approximately 5.5 months. Three brace configurations were tried and modified to improve fit and tolerance, with serial clinical and radiographic review showing no meaningful correction of the deformity. The child repeatedly developed apparent pain, restlessness, and crying during brace use, particularly at night; these symptoms settled after the brace was removed. After counseling, the parents declined further bracing and preferred surgery. An open-wedge tibial osteotomy was performed with drill recanalization of the medullary canals and fixation with a 2.5-mm Kirschner wire. A 1.5-cm segment of the ipsilateral distal fibula was resected, divided into two autologous grafts, and placed in the tibial wedge. At 9 years, the tibial osteotomy and fibular donor site were completely healed and remodeled, alignment was maintained, and no pathological fracture or established pseudarthrosis had occurred. The patient was pain-free, had full knee and ankle motion, and had an asymptomatic 11-mm shortening of the left lower limb. This case provides long-term documentation of an individualized prophylactic reconstruction after a prolonged, poorly tolerated trial of bracing. The result supports the technical feasibility of open-wedge correction with local fibular autograft and simple Kirschner-wire fixation, but a single case cannot establish that surgery is preferable to bracing.
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BibTeX
@article{atrushi2026congenital,
title = {{Congenital Pre-Pseudarthrosis of the Tibia: A 9-Year Follow-Up Case Report.}},
author = {Farhad Mustafa Mousa Atrushi and Ronyas Omar Hasan},
journal = {Journal of orthopaedic case reports},
year = {2026},
month = nov,
doi = {10.13107/jocr.2026.v16.i11.8480},
url = {https://europepmc.org/article/MED/42997150},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Congenital Pre-Pseudarthrosis of the Tibia: A 9-Year Follow-Up Case Report.
AU - Farhad Mustafa Mousa Atrushi
AU - Ronyas Omar Hasan
PY - 2026
DA - 2026/11/01
JO - Journal of orthopaedic case reports
DO - 10.13107/jocr.2026.v16.i11.8480
UR - https://europepmc.org/article/MED/42997150
AB - Congenital tibial pre-pseudarthrosis is the intact dysplastic stage of the congenital pseudarthrosis spectrum. Management before fracture is unsettled: Bracing is commonly used, whereas prophylactic surgery is reserved for selected circumstances. A 2-year-and-2-month-old boy had painless anterolateral bowing and dysplastic narrowing of the left tibia without pathological fracture or established pseudarthrosis. Bracing was continued for approximately 5.5 months. Three brace configurations were tried and modified to improve fit and tolerance, with serial clinical and radiographic review showing no meaningful correction of the deformity. The child repeatedly developed apparent pain, restlessness, and crying during brace use, particularly at night; these symptoms settled after the brace was removed. After counseling, the parents declined further bracing and preferred surgery. An open-wedge tibial osteotomy was performed with drill recanalization of the medullary canals and fixation with a 2.5-mm Kirschner wire. A 1.5-cm segment of the ipsilateral distal fibula was resected, divided into two autologous grafts, and placed in the tibial wedge. At 9 years, the tibial osteotomy and fibular donor site were completely healed and remodeled, alignment was maintained, and no pathological fracture or established pseudarthrosis had occurred. The patient was pain-free, had full knee and ankle motion, and had an asymptomatic 11-mm shortening of the left lower limb. This case provides long-term documentation of an individualized prophylactic reconstruction after a prolonged, poorly tolerated trial of bracing. The result supports the technical feasibility of open-wedge correction with local fibular autograft and simple Kirschner-wire fixation, but a single case cannot establish that surgery is preferable to bracing.
SN - 2250-0685
SN - 2321-3817
ER -