Treatment of Congenital Pseudarthrosis of the Tibia

Congenital Pseudarthrosis of the Tibia (CPT) is a rare condition that has traditionally been unsuccessfully treated, with a high rate of recurrent fractures and nonunion. This leads to secondary deformity of the ankle, knee, and hip, and in many cases, the decision to amputate the limb. A large variety of surgical procedures have been attempted for the treatment of fractured cases of CPT with an average rate of union without refracture of only 50%. Intentional cross-union between the tibia and fibula was proposed by both Choi and Paley and has been reported to improve the results of CPT treatment dramatically, with 100% union with no refractures. The success of the cross-union procedure is due to the combined treatment of the mechanical and biological causes of fracture in patients with CPT. The Paley Cross-Union Protocol, although very technically demanding, has radically changed the prognosis of this once sinister disease