Management of Pseudarthrosis Tibia By Physeal Distraction With Ilizarov Ring Fixator

Objective: to observe the results of chondrodiastasis/physeal distraction in the management of pseudarthrosis of tibia by ilizarov ring fixator. patients and methods: nine patients,seven males and two females,with congenital pseu-darthrosis of tibia were treated from february2008 to april 2012. the age at the onset of ilizarov treatment was 10 to 12 years. meticulous& complete resection of the sclerotic bone ends & surrounding fibrous hamartoma,and reopening of the medullary canals was done. two navigation wires were passed through both the malleoli. generous autogenous bone graft was placed,harvested from the ipsilateral iliac crest. advanced hybrid ilizarov ring fixator was applied. acute compression at the pseudarthrosis site was done. one ring was applied in the proximal tibial epiphysis. fracture was done at proximal physeal plate by rotatory movements. fibula attached proximally and distally to proximal and distal rings. distraction was started on the 5th day at the rate of 0.5 mm/24 hours for 10 days. later on distraction rate was accelerated to 1mm/day with a rhythm of 0.25 mm/6 hourly. ankle deformities were addressed accordingly. results: union was achieved in all the nine cases at the time of frame removal. all the other associated deformities were addressed simultaneously while the frame was on. leg length discrepancy was addressed by physeal distraction. growth was not arrested in all cases after phy-seal distraction. conclusion: ilizarov ring fixator remains the treatment of choice to achieve refracture free union till 4 years in congenital pseudarthrosis of tibia,one of the most perplexing and challenging orthopedic problems. and there is no physeal arrest after physeal distraction to treat leg length discrepancy.