الفهرس 
1. Fracture healingOnly 14 pages are availabe for public view
 |  | from | 101 |  |  |
| | | from | 101 | | |
Abstract
Congenital pseudarthrosis of the tibia is a relatively rare affection. This uncommon type of pseudarthrosis is one of the most difficult conditions to treat. The etiology of the congenital pseudarthrosis of the tibia is not clear. Theories have been proposed maintaining that the condition results from endocrine imbalance, fetal damage, nutritional deficiencies, infectious disease in the mother during pregnancy, genetic defects, vascular insufficiency and disturbances of neural tissue and function. While the origin of the tibia1 defect which leads to fracture and nonunion is unclear, there is good evidence that mechanical forces accentuate the problem.
Until 1930, amputation was the primary therapeutic modality for congenital pseudarthrosis. Since that time numerous therapeutic remedies have been recommended; all are surgical such as the dual onlay graft, intramedullary nailing alone or with corticoperiosteal grafts, transplantation of the fibula and multiple osteotomies with fragmentation, realignment, and intramedullary rod fixation and ilizarov external fixation. Numerous variations on each of these methods have been proposed. All have held some promise, but none has been entirely satisfactory. In the last decade, reports have documented the electrical treatment of congenital pseudarthrosis of the tibia by using continuous direct current or by using pulsing electromagnetic fields (PEMFs) (53).
Here we discuss one of these methods, The Ilizarov technique in the treatment of congenital pseudarthrosis of the tibia. The principle of treatment of congenital pseudarthrosis of the tibia with ilizarov method corrects all angular deformities and maximizes the cross sectional area of union of the pseudarthrosis. Various forces were used to treat the pseudarthrosis site including compression, distraction, open reduction, resection and shortening, resection and bone transport, and invagination of one end in the other.
There are several advantages of the Ilizarov technique for the treatment of CPT. The apparatus uses 1.5-mm k wires and is able to provide safe fixation of very small bone segments and cross joints without intra articular fixation. Osteoporosis is not a major obstacle to fixation. The apparatus is also able to apply different forces at different levels of the bone and is, therefore, able to perform combinations of compression and distraction for the purpose of healing of the pseudarthrosis, correction of deformity, filling of bone defects, and limb lengthening. The Ilizarov method is, therefore, not one technique but a variety of methods that can be used individually or in combinations and that can be modified as the situation demands.
The most advantageous aspect of this methodology is the ability to treat CPT comprehensively. One is able to address not only the tibial nonunion but also the bone defects, deformity, limb-length discrepancy, fibular nonunion, proximal fibular migration, ankle valgus, and foot contractures.
The disadvantages of the Ilizarov method are primarily related to the use of an external apparatus. External fixators are less well tolerated by patients than internal fixation devices and are prone to pin-track infections. The pin holes also create a stress riser that may lead to refracture.
Finally we can say that the Ilizarov methods rarely burn bridges. All other conventional treatment modalities are still possible should the Ilizarov fail. For these reasons, the Ilizarov methods are currently the most comprehensive yet conservative methods available for treatment of CPT (47).