Do Fibular Growth Patterns Change After Tibial-Fibular Fusion in Children With Congenital Pseudarthrosis of the Tibia?
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BACKGROUND: In order to reduce the incidence of congenital pseudarthrosis of the tibia (CPT) refracture, current tibial-fibular surgery is quite popular. The fibular growth pattern of CPT after tibial-fibular fusion is unclear. To explore the changes in fibular growth patterns in CPT patients with 3-in-1 osteosynthesis. METHODS: A retrospective analysis of 33 children with CPT who were admitted to the hospital from April 2013 to June 2020 and who underwent combined surgery with 3-in-1 osteosynthesis was performed. Among them, 19 were males, and 14 were females; 16 cases were on the left, and 17 cases were on the right. Twenty-two children with neurofibromatosis type I (NF-1) were present. The average age at the time of surgery was 33.3 months (13 to 72 mo). In this study, self-control was used, and the study group underwent combined surgery with 3-in-1 osteosynthesis on the tibia and fibula on the affected side of the children with CPT. The control group included healthy fibula and tibia from children with CPT. The patients' ankle valgus, proximal tibial-fibular epiphyseal plate distance, and ankle pain were recorded. RESULTS: In this study, with an average follow-up of 94.5 months, 18 patients developed ankle valgus, and 22 patients have proximal displacement of the fibula. No children experienced ankle pain. CONCLUSION: 3-in-1 osteosynthesis with CPT may change the growth pattern of the fibula, leading to a relative proximal shift of the fibula in relation to the tibia, but this still requires validation through a prospective multicenter large-sample investigation.