Congenital Forearm Pseudarthrosis, a Systematic Review for a Treatment Algorithm on a Rare Condition

BACKGROUND:A congenital forearm pseudarthrosis is a rare condition and is strongly associated with neurofibromatosis type 1. Several surgical techniques are described in the literature, but the most optimal treatment strategy remains unclear. This systematic review aims to develop a treatment algori...

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Published in:	Journal of pediatric orthopaedics Vol. 40; no. 5; pp. e367 - e374
Main Authors:	Siebelt, Michiel, de Vos-Jakobs, Suzanne, Koenrades, Nienke, van Nieuwenhoven, Christianne A.V., Oostenbrink, Rianne, Bramer, Wichor M., Verhaar, Jan A.N., Bessems, Gert J.H.J.M., Kempink, Dagmar R.J.
Format:	Journal Article
Language:	English
Published:	United States Wolters Kluwer Health, Inc. All rights reserved 01-05-2020 Copyright Wolters Kluwer Health, Inc. All rights reserved
Subjects:	Algorithms Bone Diseases - surgery Checklist Child Child, Preschool Data Management Female Fibula - transplantation Forearm - surgery Humans Infant Male Neurofibromatosis 1 - complications Pseudarthrosis - congenital Pseudarthrosis - surgery Radius Upper Extremity Deformities, Congenital - surgery
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Summary:	BACKGROUND:A congenital forearm pseudarthrosis is a rare condition and is strongly associated with neurofibromatosis type 1. Several surgical techniques are described in the literature, but the most optimal treatment strategy remains unclear. This systematic review aims to develop a treatment algorithm that may aid in clinical decision making. METHODS:The PROSPERO registration number for this study was CRD42018099602 and adheres to the PRISMA guidelines for systematic reviews. Embase, MEDLINE, Cochrane Central, Web of Science, and Google Scholar databases were searched for published studies reporting on congenital forearm pseudarthrosis not related to other underlying pathologies like bacterial infection or fibrous dysplasia. Results were not restricted by date or study type, only English literature was allowed. Studies were assessed for quality using the critical appraisal checklist for case reports from the Joanna Briggs Institute. Patient characteristics, underlying disease, type of surgery, union rate, and functional outcome were extracted from included studies. RESULTS:Of 829 studies identified, 47 were included in this review (17 case series and 30 case reports, a total of 84 cases). A one-bone forearm procedure showed highest union rates (92%), however, it results in loss of forearm rotation. Free vascularized fibula grafting showed high union rates (87%) and was related to good functional outcome of elbow flexion and forearm rotations. Other procedures showed disappointing outcomes. CONCLUSIONS:Congenital forearm pseudarthrosis is best treated with a free vascularized fibula grafting, a one-bone forearm procedure should be used as a salvage procedure. Evidence extracted from the case reports was sufficient to generate a treatment algorithm to be used in clinical pediatric practice. LEVEL OF EVIDENCE:Level IV—therapeutic.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Undefined-1 ObjectType-Feature-3 content type line 23
ISSN:	0271-6798 1539-2570
DOI:	10.1097/BPO.0000000000001417