German Congress of Orthopaedics and Traumatology (DKOU 2025)
Intramedullary tibial lengthening in congenital pseudarthrosis of the tibia
2Klinik für Allgemeine Orthopädie und Tumororthopädie, Universitätsklinikum Münster, Münster, Deutschland
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Objectives and questions: Treatment of congenital pseudarthrosis of the tibia (CPT) remains challenging, with a high failure rate of surgical procedures. When a pathological fracture occurs, treatment with external fixation is a common therapeutic approach, which can also address existing leg length discrepancies (LLD). However, even after successful reconstruction without re-fracture, relevant LLD often re-emerges during continued growth. Distraction osteogenesis with intramedullary lengthening devices is an established technique for limb lengthening, but its use in LLD due to CPT has not yet been described.
Material and methods: Retrospective evaluation of clinical and radiological data of 28 patients who were surgically treated for CPT between 2014–2024. In 7/28 patients, an intramedullary limb lengthening procedure was performed. Five of these seven patients underwent tibial lengthening and were included in the study. The mean follow-up was 15 months.
Results: The average number of previous surgeries per patient was six (1–10). The average age at the time of implantation of the lengthening nail was 17 years. Nail insertion was antegrade in three patients and retrograde in two, due to pre-existing ankle arthrodesis. The initial LLD averaged 65 mm (40–90). The average distraction distance was 42 mm (30–50). The average consolidation index (CI) was 36 days/cm (26–55). In one patient with LLD of 80 mm, an initial lengthening of 50 mm was performed. After consolidation of the regenerate, a re-osteotomy and reloading of the nail was conducted for further distraction of 30 mm. In one patient, due to an implant-associated infection, implants were removed nine months postoperatively. In another patient, an atraumatic fracture of the distal tibia occurred ten weeks after the end of distraction, and exchange nailing to a trauma nail was performed. Full bony consolidation was achieved afterward (Figure 1 [Abb. 1]).
Figure 1: A: 6-year-old female with CPT and prior failed surgeries. B: Residual LLD of 5 cm at age 15, after CPT consolidation. C: Fracture T the distal tibia after successful intramedullary lengthening of 4 cm. D: Exchange nailing procedure. E: Intended residual LLD of 1 cm due to ankle fusion; full consolidation of the regenerate bone and fracture site.
Discussion and conclusions: Intramedullary tibial lengthening can be considered for CPT with significant residual LLD after successful pseudarthrosis treatment. No delayed consolidation of the regenerate bone was found in this case series. Further studies in a larger patient cohort are needed to investigate a potentially increased complication risk.
