Treatment Strategies

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A multitude of treatment strategies have been described and proposed over the years for congenital pseudarthrosis of the tibia. Due to the complex and difficult nature of CPT, these treatment strategies have had varying degrees of success. Most of these treatments focused on stimulating the healing process through the use of bone grafts and fixation techniques. Many different bone grafts and fixation methods have been proposed.

Whatever the treatment method used, the natural history of CPT is that the affected bone segment remains atrophic (thin and weak) and poorly consolidated, resulting in a high tendency to refracture. The high refracture rate is because many treatment strategies fail to address the underlying problem. The connection between poor blood flow to the periosteum and CPT led Dr. Paley to develop a new treatment strategy with excellent results: union in all cases, equal limb length in all cases, deformity correction in all cases, and refreacture in zero cases.

The primary goals for treatment of CPT are:

  • Union
  • No refractures
  • Correct diaphyseal deformity

The secondary goals for treatment include:

  • Correct ankle-knee valgus
  • Treat limb length discrepancy
  • Correct foot deformity

Dr. Paley has experienced remarkable success with his treatment of CPT. By combining multiple techniques (i.e. periosteal graft, bone graft, BMP insertion, zometa infusion, external fixation, internal fixation, and bracing) he has achieved union in all cases with zero refractures.

Dr. Paley's current treatment strategy for CPT is the culmination of 28 years of treatment, with constant modification of his technique to improve results. Dr. Paley has published 4 papers on the treatment of CPT, with each paper reporting better results.

First paper: 1992

  • Methods: Ilizarov fixator, bone graft
  • Results: 100% union, 68% refracture rate

Second paper: 1998

  • Methods: Ilizarov fixator, bone graft, and intramedullary rodding
  • Results: 100% union, 29% refracture rate

Third paper: 2008

  • Methods: Ilizarov fixator, bone graft, intramedullary rodding, periosteal graft, BMP insertion
  • Results: 100% union, 20% refracture rate

Fourth paper: 2012

  • Methods: Ilizarov fixator, bone graft, intramedullary rodding, periosteal graft, BMP insertion, zolidronic acid infusion, and tibio-fibular cross union
  • Results: 100% union, 0% refracture rate

Dr. Paley has experienced remarkable success with his current treatment of CPT. External fixation and bone grafting has consistently resulted in 100% union, but the difficulty was in maintaining correction without refracture. By constantly modifiying his technique throughout his career and by adding and combining multiple techniques (i.e. external fixator, bone graft, intramedullary rodding, periosteal graft, BMP insertion, zolidronic acid infusion, and tibio-fibular cross union) Dr. Paley has achieved union in all cases with zero refractures. This is an unprecedented result for this condition.

The specific treatment will depend on the type of CPT:

  • Type 1
  • Type 2
  • Type 3