Eleven children in whom a tibial fracture occurred after minor trauma
had pre-existing dysplastic changes evident radiographically. These changes
included cortical tapering, sclerosis, and formation of a cyst in the
region of the medullary canal. Ten of the eleven patients had had no more
fractures an average of fifteen years after the most recent fracture. Six
of the fractures healed following prolonged immobilization in a cast, but
four of the six tibiae were abnormally bowed anteriorly, and it was thought
that a stress fracture could occur in the future. Four of the patients had
a clinically straight tibia and radiographic evidence of thick cortices
following corrective osteotomy, intramedullary fixation with bone-grafting,
and prolonged immobilization in a cast. At the most recent follow-up
examination, the eleventh patient had a persistent pseudarthrosis despite
several operative procedures. While there were too few patients in this
series for us to draw definite conclusions, our findings suggest that
late-onset pseudarthrosis of a dysplastic tibia has a better prognosis than
does congenital pseudarthrosis.