PARAMUS, N.J. -- Tibial pseudarthrosis is a fracture of the tibia that doesn't heal correctly. This incorrect healing is referred to by orthopedists as "nonunion" and is associated with neurofibromatosis, a genetic disorder in which tumors grow in the nervous system and under the skin.
Children with neurofibromatosis often have a bowing of the tibia and are first examined by a pediatric neurologist, followed by a geneticist and orthopedist. Up to half of the children first seen by an orthopedist for anterolateral bowing of the tibia won’t have a diagnosis of neurofibromatosis, but by maturity, 80-90 percent will show signs of the disease.
Patients with an anterolateral bow without a fracture are treated with braces throughout childhood. As children get older, the risk of fracture tends to decrease. The brace may be discarded when the child reaches maturity, but patients with abnormal development of the tibia may need to be monitored throughout their lives.
Surgical intervention is recommended for children with fractures and pseudarthrosis. The most common procedure involves use of a bone graft and intramedullary rod to promote healing. With this surgical approach, patients may also require leg lengthening to restore growth lost in the tibia.
While none of these techniques are perfect, 90 percent of patients can expect to heal using these methods.
Dr. Roger Widmann is a pediatric orthopedic surgeon and the Chief of Pediatric Orthopedic Surgery at Hospital for Special Surgery. He practices at both the HSS Outpatient Center in Paramus and the hospital’s main campus in New York.