Surgical treatment of congenital pseudarthrosis of the forearm: Review and quantitative analysis of individual patient data

There is little scientific evidence on the best surgical treatment for congenital pseudarthrosis of the forearm due to the rarity of this condition (less than 100 cases described in the literature) and the lack of comparative studies. Our aim was to provide evidence in favor of a certain surgical technique. A comprehensive review of the literature was performed using case series and case reports. The statistical analysis was based on individual patient data to mimic a case-control study. A multiple logistic regression was used to assess the effect of each independent variable (neurofibromatosis status, location of the pseudarthrosis, age at first surgery and type of treatment) on bone union at last follow-up (yes/no). The database searches yielded 1112 articles; 55 articles were selected, reporting on 94 cases. Seventy patients had healed completely at the last follow-up (74%). Neither the age at surgery nor the location of the pseudarthrosis was related to union (P > 0.7). The patients’ neurofibromatosis type 1 status was weakly related to healing (P = 0.06). Vascularized fibula transfer had a higher rate of healing (100%) than did non-vascularized bone graft (70%) (P =0.002). Level of evidence: 4 (case-control study of data from case series and case reports).