Anterolateral Bowing & Congenital Pseudoarthrosis of Tibia

DISCUSSION: Anterolateral tibial bowing and congenital pseudoarthrosis of the tibia are related conditions and represent a continuum of the same disease process. It is most commonly seen in children with neurofibromatosis. The radiograph in Illustration A is an example of anterolateral tibial bowing. The radiograph in in Illustration B is an example of congenital pseudoarthrosis of the tibia.

The cited reference by Gilbert et al suggested that vascularized fibular transplantation was the most effective and safest surgical technique to treat congenital pseudarthrosis of the tibia. Other options to treat this condition include intramedullary fixation (Williams rod), prophylactic (placed before fracture occurs) fibular allograft, and external fixation, all with various uses of autograft and bone graft extenders. There are various tibial bowing conditions found in children and one should be familiar with the differential diagnosis and associated conditions. Bowing of the tibia that is present at birth typically occurs either anteriorly (in association with fibular hemimelia), anterolaterally (in association with congenital pseudoarthrosis), or posteromedially (in association with calcaneovalgus foot deformity). Congential talipes equinovarus (clubfoot) and congenital vertical talus are not associated with any specific tibial bowing deformities.