Salvage Treatment of Failed Congenital Pseudarthrosis of the Tibia Using Transcalcaneal Intramedullary Fixation Combined with Ilizarov External Fixation: A Prospective Clinical Series from Bangladesh

Open Access

Abstract

Background: Congenital pseudarthrosis of the tibia (CPT) represents one of the most challenging orthopaedic conditions in paediatric practice, characterized by spontaneous anterolateral tibial bowing, pathological fracture, and persistent nonunion resistant to conventional treatment. Salvage management of treatment-failed cases requires a multifaceted approach addressing both the compromised bone biology and mechanical instability. Objectives: To evaluate clinical and radiological outcomes of salvage reconstruction for failed CPT using transcalcaneal intramedullary rod fixation combined with Ilizarov external fixation. Methods & Materials: A prospective observational cohort study conducted at NITOR, Dhaka, Bangladesh (July 2021-July 2025). Fifteen consecutive patients with failed CPT treated using combined transcalcaneal intramedullary nail fixation and two-ring Ilizarov external fixation were enrolled. Mean age was 6.5 years (range 3-12 years); mean follow-up was 42 months (range 19.2-74.4 months). Results: Final radiographic union was achieved in 14 of 15 patients (93.3%), with one case of persistent nonunion (6.7%). No refractures occurred following initial union (0%; 0/15). Acceptable alignment was maintained in all patients (100%; 15/15). Mean time to union was 9 months (range 6-12 months). Pin-tract infection occurred in 5 patients (33.3%), deep infection in 1 (6.7%), delayed union in 2 (13.3%), and implant migration in 2 (13.3%). AOFAS scores improved from mean 40 (preoperative) to 64 (final follow-up). Conclusion: Salvage reconstruction combining transcalcaneal intramedullary fixation with Ilizarov external fixation achieved union in 93.3% of failed CPT cases. This combined strategy effectively addresses the complex pathobiology of treatment-failed cases, providing durable stability and acceptable functional outcomes, though pin-tract infection and implant-related complications require careful management.