Pseudoarthrosis of the leg. Problems, possible solutions

Purpose. To determine the main directions and evaluate the efficiency of the technologies used in treatment of pseudoarthrosis of the leg bones. Materials and Methods. The results of 57 patients treated in FSBI “RISC RTO” and in the Department of Surgical Orthopaedics A of the University Medical Center de DOUERA (Blida, Algeria) within the period of 2000-2013 (25 boys and 32 girls) analyzed. Mean age of the patients - 10.5 years. 17 (30 %) patients operated for the first time, 38 (67 %) patients underwent from two to eight surgeries before applying to our clinics. Two (3 %) patients underwent more than eight interventions at the previous stages of treatment. The Ilizarov method was used by the authors in 37 cases (65 %) (Group 1), the method of inductive Masquelet membrane - in 12 (21 %) cases (Group 2), and extensive resection of bone part with further defect filling using an autograft performed in three clinical cases (5 %) (Group 3). Clinical examples presented. Results. The mean period of treatment in Group 1 was 246.4 days (monolocal compression-distraction), 219.7 days (bilocal compression-distraction), and 215 days (polylocal compression-distraction osteosynthesis). The fragments of leg bones lengthened by 9.3±3.8 cm on the average. Among the patients of Group 2 consolidation achieved in eight cases of 12, it was insufficient in two patients, and the result was not achieved in another two patients due to total lysis of the graft. The mean period of consolidation was six (6) months (range: 4-8 months). Additional bone transplantation required in six patients in order to increase the bone mass in the focus. In Group 3 consolidation achieved in two patients, and additional transplantation required for one of them for the graft thickening, after that consolidation achieved. Conclusion. The main methodological principles of treating congenital pseudoarthroses of the leg should be based on using different variants of osteoplastic interventions and osteoinductive materials in pseudoarthrosis zone, as well as on additional reinforcement with various implants (wires, rods). The use of combined variants of external and internal osteosynthesis is promising.