BACKGROUND: Free vascularized fibular graft (FVFG) has been recognized as a curative surgical treatment for congenital pseudarthrosis of the tibia (CPT). However, bone union is not always obtained in some patients, and refracture often occurs in others even after union is achieved. To avoid such complications, we have designed a new split-tibia coaptation technique (STCT) for FVFG. METHODS: We performed FVFG using STCT in 2 patients with CPT. Both the proximal and distal stumps of the tibia were split longitudinally into 2 with minimum tibial resection, and then a fibular graft was placed into the formed gutters and stabilized by external fixation. RESULTS: Successful bone union was achieved at postoperative weeks 13 and 12, respectively. The diameter of each fibular graft was enlarged to 107% and 83% of the contralateral tibia, and refracture did not occur during the follow-up periods of almost 7 and 4 years. Both the patients could walk without any limitations. CONCLUSIONS: This novel coaptation technique for FVFG provides early bone union, enlargement of graft diameter, and prevention against refracture in patients with CPT.
BACKGROUND: Free vascularized fibular graft (FVFG) has been recognized as a curative surgical treatment for congenital pseudarthrosis of the tibia (CPT). However, bone union is not always obtained in some patients, and refracture often occurs in others even after union is achieved. To avoid such complications, we have designed a new split-tibia coaptation technique (STCT) for FVFG. METHODS: We performed FVFG using STCT in 2 patients with CPT. Both the proximal and distal stumps of the tibia were split longitudinally into 2 with minimum tibial resection, and then a fibular graft was placed into the formed gutters and stabilized by external fixation. RESULTS: Successful bone union was achieved at postoperative weeks 13 and 12, respectively. The diameter of each fibular graft was enlarged to 107% and 83% of the contralateral tibia, and refracture did not occur during the follow-up periods of almost 7 and 4 years. Both the patients could walk without any limitations. CONCLUSIONS: This novel coaptation technique for FVFG provides early bone union, enlargement of graft diameter, and prevention against refracture in patients with CPT.