Hasil untuk "Orthopedic surgery"

Mads Emil Jacobsen, MD, Kristoffer Borbjerg Hare, MD, PhD, Nanna Sillesen, MD, PhD et al.

Background:. Competency-based medical education relies on assessment to evaluate performance and guide learning. This study compared the validity evidence and psychometric performance of the Objective Structured Assessment of Technical Skills (OSATS), adapted for distal radius fracture fixation, with a procedure-specific instrument—the Distal Radius Fracture Assessment of Technical Expertise (DRF-RATE)—for assessing technical performance during volar locking plate (VLP) fixation of distal radius fractures (DRFs). Methods:. First-year orthopaedic residents (n = 12) and practicing trauma or hand surgeons (n = 13) performed standardized VLP fixation on a cadaveric DRF model. Anonymous video recordings were independently assessed by 2 orthopaedic trauma surgeons and 2 hand surgeons using either OSATS or DRF-RATE. Validity evidence was gathered in accordance with the Messick contemporary validity framework. Results:. Internal consistency reliability was good-to-excellent for OSATS (α = 0.82-0.98) and DRF-RATE (α = 0.95). Interrater reliability was weaker for OSATS (r = 0.59-0.69) than for DRF-RATE (r = 0.78), though both demonstrated systematic rater bias. OSATS discriminated between novices and experienced surgeons (p = 0.02), whereas DRF-RATE demonstrated even stronger discrimination (p < 0.001). Contrasting-groups analysis revealed higher misclassification rates with OSATS (21%-40%) than DRF-RATE (11%-13%), indicating superior accuracy for the latter. Conclusions:. The DRF-RATE demonstrated stronger and more comprehensive validity evidence than the modified OSATS, with better reliability, higher discrimination and classification accuracy, and overall superior psychometric performance compared with OSATS. Its procedural granularity and structured design address key limitations of OSATS and support detailed, high-quality formative feedback for distal radius fracture fixation.

Danko Dan Milinkovic, Riccardo D'Ambrosi, John Xerogeanes et al.

Abstract Purpose To evaluate current preferences, techniques and indications regarding the use of the quadriceps tendon (QT) autograft for anterior cruciate ligament reconstruction (ACLR) among members of the International Quadriceps Tendon Interest (IQTI) group. Methods An online survey consisting of 30 single‐ and multiple‐choice questions was distributed to all IQTI members (n = 45), representing an international group of orthopaedic surgeons with specific expertise in QT‐based ACLR. The survey was conducted in conjunction with the second IQTI meeting, and responses were collected over a 2‐month period (June–July 2025). Results Thirty‐two high‐volume, experienced surgeons completed the questionnaire (32/45; response rate, 71%; 28 male and 4 female). The QT was the preferred primary graft choice for ACLR in 61% (n = 20) of respondents, while 89% (n = 28) used it for revision ACLR and 72% (n = 23) for multiligamentous injuries. Preoperative QT measurement with magnetic resonance imaging (MRI) or ultrasound was performed always or often by 34% (n = 11). Tendon defect closure after harvest was routinely performed by 94% (n = 30), and 33% (n = 11) reported always or often harvesting a bone block. Adjustable‐loop suspensory fixation was most commonly used on the femoral side (61%, n = 20), whereas tibial fixation was most frequently achieved with interference screws (72%, n = 23). One‐third of surgeons (33%, n = 11) reported modifying their rehabilitation protocol when using QT compared with other grafts. The most frequently observed short‐term complications were transient quadriceps weakness and extensor lag. Conclusion This international survey shows that the QT autograft is a well‐established option in ACLR among experienced knee surgeons, particularly in revision and complex settings. At the same time, persistent variability in primary graft selection and reported rehabilitation and technical considerations indicate that QT use remains individualized within a spectrum of effective autograft choices. Level of Evidence Level V, expert statement.

João Paulo Machado Bergamaschi, Ariel Falbel Lugão, Rangel Roberto de Assis et al.

Xufeng Chu, Hailin Xing, Minghao Chao et al.

Osteoporosis is a multifactorial bone metabolic disorder characterized by the deterioration of bone mass and microarchitecture, leading to increased fragility and fracture risk. Recent advances have revealed the critical role of the gut microbiota in the pathogenesis of osteoporosis, primarily mediated by metabolite-driven and immune-mediated interactions along the gut–bone axis. Dysbiosis, or microbial imbalance, can influence bone health by modulating host metabolism, immune function, and endocrine responses. While growing evidence suggests that gut microbiota modulation holds therapeutic potential for osteoporosis, the underlying mechanisms remain poorly understood. This review examines the latest findings on the role of prebiotics, probiotics, and natural bioactive substances in modulating the gut microbiota to improve bone health. We discuss how these interventions may restore microbial balance, enhance gut barrier function, and reduce systemic inflammation, thereby influencing bone metabolism. A deeper understanding of the gut–bone axis will pave the way for more targeted, effective, and personalized therapeutic strategies for osteoporosis prevention and treatment.

Rachit Saggar MBBS, Joseph Mullen BS, Warren Austin et al.

Research Type: Level 4 – Case series Introduction/Purpose: Primary Achilles tendon ruptures are common injuries and typically result from acute loading associated with sudden and forceful contraction of the gastrocnemius. Various surgical techniques exist that allow decreased re-rupture rates and faster return to play. The giftbox technique demonstrates improvement in the biomechanical properties of acute Achilles tendon repairs and decreased re-rupture rates compared to prior techniques (Labib et al. 2009; Labib et al. 2016). However, re-ruptures still occur. For this reason, this project explores a modification to the giftbox technique, where the proximal and distal free suture ends are passed anteriorly to the tendon and tied at lateral struts. Specifically, the purpose is to evaluate the functional outcomes observed with this novel technique. Methods: An institution-based registry with foot and ankle patient data that was prospectively collected was queried. Consecutive patients who underwent surgical repair of acute Achilles tendon ruptures between June 2017 and March 2023 with the senior author’s modified giftbox technique were evaluated. The inclusion criteria were patients who had an acute primary Achilles tendon rupture within six weeks prior to surgery, clinical diagnosis, and underwent surgical repair. Patients with ipsilateral ankle pathology and revision surgeries were excluded from the study. Patient reported outcome measures (PROMs) were obtained preoperatively and at 6 month, and ≥1-year postoperative clinic visit with the validated Foot and Ankle Ability Measure Activities of Daily Living (FAAM ADL) subscale, PROMIS Mental Health, and PROMIS Physical Health. PROMs were compared to the preoperative scores with a paired t-test and 95% confidence intervals were reported. Results: 56 patients were identified who had undergone acute Achilles tendon rupture repair with the modified giftbox technique and were included in this study (14 females). All patients completed a preoperative survey, 46 (82%) patients completed a 1-month postoperative PROM survey, 51 (91%) completed a 3-month postoperative PROM, 50 (89.3%) completed a 6-month postoperative PROM, and 54 (96%) patients completed a final postoperative PROM, with a minimum of 1-year. Mean follow-up was 2.85 years. The PROM results are summarized in Table 1. Notably, a significant improvement in all scores except PROMIS-MH was observed starting at the 3-month visit. Patients continued to progress with each visit. Overall complication rate was 10.7% consisting of 1 re-rupture, 1 infection, 1 neuropathy, and 3 delayed wound healing. Conclusion: This study clinically assesses a novel modified giftbox technique for treating acute Achilles tendon ruptures, revealing improved functional outcomes based on FAAM (ADL and Sport), PROMIS-PH, and VAS in both mid-term and long-term follow-ups. The novel modified giftbox technique is suitable for surgical repair of acute Achilles tendon ruptures, and results compare well to historical reports of re-rupture, infection, and wound complication rates. Furthermore, this provides a comprehensive overview of patient standards at each interval.

Richard Andreas Lindtner, Lukas Kampik, Larissa Noack et al.

Bone infections caused by Staphylococcus aureus and Staphylococcus epidermidis are serious complications in orthopedic surgery. These infections commonly occur in joint replacements, fracture management, and bone grafting procedures. Rapid and accurate pathogen-specific diagnostic methods are urgently needed to support early clinical decisions. Current culture-based methods are slow and delay effective treatment. This study evaluated the diagnostic value of combining Raman microscopy with high-resolution micro-computed tomography (micro-CT). Human bone samples, either uninfected or inoculated with S. aureus or S. epidermidis, were analyzed. Raman spectroscopy detected distinct spectral changes in inoculated bones, including reduced intensity of phosphate (v1PO43−), Amide III, and CH2 deformation bands. A single principal component explained 96%–98% of the variance in these infection-related markers. Specifically, the v1PO43− and CH2 deformation bands effectively differentiated between S. aureus and S. epidermidis infections, capturing 99%–100% variance. Micro-CT analysis showed significant structural changes in inoculated bones. Trabecular volume, number, and spacing were particularly affected. Among these, VOX-BV/TV and Mean1 best differentiated between S. aureus and S. epidermidis infections (both p &lt; 0.0001). Support vector machine (SVM) classification repeated stratified k-folg cross-validation accurately detected inoculation status. Combining Raman and micro-CT features yielded moderately improved classification performance in pathogen-specific discrimination. These findings demonstrate that combining molecular (Raman spectroscopy) and structural (micro-CT) methods allows rapid, non-destructive diagnosis of bone infections. This multimodal approach may improve diagnostic precision, supports timely clinical decisions, and ultimately improves patient outcomes in orthopedic and trauma surgery.

Walid Shaker, Mustafa Suphi Erden

Robotic surgery represents a major breakthrough in medical interventions, which has revolutionized surgical procedures. However, the high cost and limited accessibility of robotic surgery systems pose significant challenges for training purposes. This study addresses these issues by developing a cost-effective robotic laparoscopy training system that closely replicates advanced robotic surgery setups to ensure broad access for both on-site and remote users. Key innovations include the design of a low-cost robotic end-effector that effectively mimics high-end laparoscopic instruments. Additionally, a digital twin platform was established, facilitating detailed simulation, testing, and real-time monitoring, which enhances both system development and deployment. Furthermore, teleoperation control was optimized, leading to improved trajectory tracking while maintaining remote center of motion (RCM) constraint, with a RMSE of 5 μm and reduced system latency to 0.01 seconds. As a result, the system provides smooth, continuous motion and incorporates essential safety features, making it a highly effective tool for laparoscopic training.

Yuwu Liu, Qun Gao

Abstract Aims Knee osteoarthritis (KOA) is a common degenerative joint disease characterized by pain and functional limitations. Current treatments offer symptomatic relief but do not address the underlying pathology. This study explores the role of the infrapatellar fat pad (IFP) in KOA and evaluates the efficacy of its partial arthroscopic excision. Methods A retrospective review was conducted on 37 KOA patients who underwent partial IFP excision. Pain and function were assessed using the WOMAC and VAS scores, while MRI evaluations focused on cartilage health. Results Significant postoperative improvements were observed in both pain and functional outcomes, with substantial reductions in WOMAC and VAS scores (P < 0.001). MRI findings demonstrated notable enhancements in cartilage integrity, reflected in significantly improved WORMS scores (P < 0.001). Conclusions Partial excision of the IFP significantly reduces pain and improves function in KOA patients, while also promoting cartilage health. These findings support the IFP’s role in KOA pathology and highlight the potential benefits of targeted surgical intervention.

Na Yuan, Weiying Zhang, Weizhou Yang et al.

Abstract Inflammatory reactions are involved in the development of steroid-induced osteonecrosis of the femoral head(ONFH). Studies have explored the therapeutic efficacy of inhibiting inflammatory reactions in steroid-induced ONFH and revealed that inhibiting inflammation may be a new strategy for preventing the development of steroid-induced ONFH. Exosomes derived from M2 macrophages(M2-Exos) display anti-inflammatory properties. This study aimed to examine the preventive effect of M2-Exos on early-stage steroid-induced ONFH and explore the underlying mechanisms involved. In vitro, we explored the effect of M2-Exos on the proliferation and osteogenic differentiation of bone marrow-derived mesenchymal stem cells(BMMSCs). In vivo, we investigated the role of M2-Exos on inflammation, osteoclastogenesis, osteogenesis and angiogenesis in an early-stage rat model of steroid-induced ONFH. We found that M2-Exos promoted the proliferation and osteogenic differentiation of BMMSCs. Additionally, M2-Exos effectively attenuated the osteonecrotic changes, inhibited the expression of proinflammatory mediators, promoted osteogenesis and angiogenesis, reduced osteoclastogenesis, and regulated the polarization of M1/M2 macrophages in steroid-induced ONFH. Taken together, our data suggest that M2-Exos are effective at preventing steroid-induced ONFH. These findings may be helpful for providing a potential strategy to prevent the development of steroid-induced ONFH.

Bhuvan Sachdeva, Naren Akash, Tajamul Ashraf et al.

Cataract surgery is the most common surgical procedure globally, with a disproportionately higher burden in developing countries. While automated surgical video analysis has been explored in general surgery, its application to ophthalmic procedures remains limited. Existing works primarily focus on Phaco cataract surgery, an expensive technique not accessible in regions where cataract treatment is most needed. In contrast, Manual Small-Incision Cataract Surgery (MSICS) is the preferred low-cost, faster alternative in high-volume settings and for challenging cases. However, no dataset exists for MSICS. To address this gap, we introduce Sankara-MSICS, the first comprehensive dataset containing 53 surgical videos annotated for 18 surgical phases and 3,527 frames with 13 surgical tools at the pixel level. We benchmark this dataset on state-of-the-art models and present ToolSeg, a novel framework that enhances tool segmentation by introducing a phase-conditional decoder and a simple yet effective semi-supervised setup leveraging pseudo-labels from foundation models. Our approach significantly improves segmentation performance, achieving a $23.77\%$ to $38.10\%$ increase in mean Dice scores, with a notable boost for tools that are less prevalent and small. Furthermore, we demonstrate that ToolSeg generalizes to other surgical settings, showcasing its effectiveness on the CaDIS dataset.

Syed Abdul Mateen, Niharika Malvia, Syed Abdul Khader et al.

This paper presents an approach for surgical phase recognition using video data, aiming to provide a comprehensive understanding of surgical procedures for automated workflow analysis. The advent of robotic surgery, digitized operating rooms, and the generation of vast amounts of data have opened doors for the application of machine learning and computer vision in the analysis of surgical videos. Among these advancements, Surgical Phase Recognition(SPR) stands out as an emerging technology that has the potential to recognize and assess the ongoing surgical scenario, summarize the surgery, evaluate surgical skills, offer surgical decision support, and facilitate medical training. In this paper, we analyse and evaluate both frame-based and video clipping-based phase recognition on thoracic surgery dataset consisting of 11 classes of phases. Specifically, we utilize ImageNet ViT for image-based classification and VideoMAE as the baseline model for video-based classification. We show that Masked Video Distillation(MVD) exhibits superior performance, achieving a top-1 accuracy of 72.9%, compared to 52.31% achieved by ImageNet ViT. These findings underscore the efficacy of video-based classifiers over their image-based counterparts in surgical phase recognition tasks.

Hudson Leone, Thinh Le, S. Srikara et al.

We present estimates for the number of ions needed to implement fault-tolerant lattice surgery between spatially separated trapped-ion surface codes. Additionally, we determine attainable lattice surgery rates given a number of dedicated ``communication ions" per logical qubit. Because our analysis depends heavily on the rate that syndrome extraction cycles take place, we survey the state-of the art and propose three possible cycle times between $10$ and $1000 μs$ that we could reasonably see realised provided certain technological milestones are met. Consequently, our numerical results indicate that hundreds of resource ions will be needed for lattice surgery in the slowest case, while close to a hundred thousand will be needed in the fastest case. The main factor contributing to these prohibitive estimates is the limited rate that ions can be coupled across traps. Our results indicate an urgent need for optical coupling to improve by one or more orders of magnitude for trapped-ion quantum computers to scale.

Michael A. Quacinella, DO, MPH, Taylor M. Yong, MD, MS, William T. Obremskey, MD, MPH, MMHC et al.

Summary:. The use of negative pressure wound therapy (NPWT) continues to be an important tool for surgeons. As the use and general acceptance of NPWT have grown, so have the indications for its use. These indications have expanded to include soft tissue defects in trauma, infection, surgical wound management, and soft tissue grafting procedures. Many adjuvants have been engineered into newer generations of NPWT devices such as wound instillation of fluid or antibiotics allowing surgeons to further optimize the wound healing environment or aid in the eradication of infection. This review discusses the recent relevant literature on the proposed mechanisms of action, available adjuvants, and the required components needed to safely apply NPWT. The supporting evidence for the use of NPWT in traumatic extremity injuries, infection control, and wound care is also reviewed. Although NPWT has a low rate of complication, the surgeon should be aware of the potential risks associated with its use. Furthermore, the expanding indications for the use of NPWT are explored, and areas for future innovation and research are discussed.

LuLu Yi, ChangJun Song, YuanYuan Liu et al.

Abstract Objective Ankylosing spondylitis (AS) is a progressive systemic disease characterized by a chronic inflammatory response in the sacroiliac joints and spine. Long noncoding RNAs suggest significant actions in the progression of AS. Therefore, a specific lncRNA, highly upregulated in liver cancer (HULC), was studied here regarding its functions and related mechanisms in AS. Methods Measurements of miR-556-5p, HULC, and YAP1 expression were performed on AS cartilage tissues and chondrocytes. The interaction between miR-556-5p and HULC or YAP1 was verified. CCK-8, flow cytometry and enzyme-linked immunosorbent assay were used to evaluate the effects of HULC, miR-556-5p, and YAP1 on the proliferation, apoptosis, and inflammatory response of AS chondrocytes. Furthermore, the action of HULC/miR-556-5p/YAP1 was experimentally observed in AS mice. Results HULC and YAP1 levels were augmented, while miR-556-5p levels were suppressed in AS cartilage tissues and chondrocytes. Downregulating HULC or upregulating miR-556-5p stimulated chondrocyte proliferation and inhibited apoptosis and inflammation in AS. miR-556-5p was a downstream factor of HULC, and YAP1 was a potential target of miR-556-5p. The improvement effect of downregulated HULC on AS chondrocytes was saved when YAP1 expression was forced. In addition, silence of HULC improved the pathological injury of spinal cartilage in AS mice by enhancing miR-556-5p-related regulation of YAP1. Conclusion HULC inhibition relieves the inflammatory response in AS by reducing miR-556-5p-mediated YAP1 expression.

Abhilash R. Hareendranathan, Stephanie Wichuk, Kumaradevan Punithakumar et al.

AimsStudies of infant hip development to date have been limited by considering only the changes in appearance of a single ultrasound slice (Graf’s standard plane). We used 3D ultrasound (3DUS) to establish maturation curves of normal infant hip development, quantifying variation by age, sex, side, and anteroposterior location in the hip.MethodsWe analyzed 3DUS scans of 519 infants (mean age 64 days (6 to 111 days)) presenting at a tertiary children’s hospital for suspicion of developmental dysplasia of the hip (DDH). Hips that did not require ultrasound follow-up or treatment were classified as ‘typically developing’. We calculated traditional DDH indices like α angle (αSP), femoral head coverage (FHCSP), and several novel indices from 3DUS like the acetabular contact angle (ACA) and osculating circle radius (OCR) using custom software.Resultsα angle, FHC, and ACA indices increased and OCR decreased significantly by age in the first four months, mean αSP rose from 62.2° (SD 5.7°) to 67.3° (SD 5.2°) (p < 0.001) in one- to eight- and nine- to 16-week-old infants, respectively. Mean αSP and mean FHCSP were significantly, but only slightly, lower in females than in males. There was no statistically significant difference in DDH indices observed between left and right hip. All 3DUS indices varied significantly between anterior and posterior section of the hip. Mean 3D indices of α angle and FHC were significantly lower anteriorly than posteriorly: αAnt = 58.2° (SD 6.1°), αPost = 63.8° (SD 6.3°) (p < 0.001), FHCAnt = 43.0 (SD 7.4), and FHCPost = 55.4° (SD 11.2°) (p < 0.001). Acetabular rounding measured byOCR indices was significantly greater in the anterior section of the hip (p < 0.001).ConclusionWe used 3DUS to show that hip shape and normal growth pattern vary significantly between anterior and posterior regions, by magnitudes similar to age-related changes. This highlights the need for careful selection of the Graf plane during 2D ultrasound examination. Whole-joint evaluation by obtaining either 3DUS or manual ‘sweep’ video images provides more comprehensive DDH assessment.Cite this article: Bone Jt Open 2022;3(11):913–923.

Yuehao Wang, Yonghao Long, Siu Hin Fan et al.

Reconstruction of the soft tissues in robotic surgery from endoscopic stereo videos is important for many applications such as intra-operative navigation and image-guided robotic surgery automation. Previous works on this task mainly rely on SLAM-based approaches, which struggle to handle complex surgical scenes. Inspired by recent progress in neural rendering, we present a novel framework for deformable tissue reconstruction from binocular captures in robotic surgery under the single-viewpoint setting. Our framework adopts dynamic neural radiance fields to represent deformable surgical scenes in MLPs and optimize shapes and deformations in a learning-based manner. In addition to non-rigid deformations, tool occlusion and poor 3D clues from a single viewpoint are also particular challenges in soft tissue reconstruction. To overcome these difficulties, we present a series of strategies of tool mask-guided ray casting, stereo depth-cueing ray marching and stereo depth-supervised optimization. With experiments on DaVinci robotic surgery videos, our method significantly outperforms the current state-of-the-art reconstruction method for handling various complex non-rigid deformations. To our best knowledge, this is the first work leveraging neural rendering for surgical scene 3D reconstruction with remarkable potential demonstrated. Code is available at: https://github.com/med-air/EndoNeRF.

Yonghao Long, Jianfeng Cao, Anton Deguet et al.

Robot-assisted surgery has become progressively more and more popular due to its clinical advantages. In the meanwhile, the artificial intelligence and augmented reality in robotic surgery are developing rapidly and receive lots of attention. However, current methods have not discussed the coherent integration of AI and AR in robotic surgery. In this paper, we develop a novel system by seamlessly merging artificial intelligence module and augmented reality visualization to automatically generate the surgical guidance for robotic surgery education. Specifically, we first leverage reinforcement leaning to learn from expert demonstration and then generate 3D guidance trajectory, providing prior context information of the surgical procedure. Along with other information such as text hint, the 3D trajectory is then overlaid in the stereo view of dVRK, where the user can perceive the 3D guidance and learn the procedure. The proposed system is evaluated through a preliminary experiment on surgical education task peg-transfer, which proves its feasibility and potential as the next generation of robot-assisted surgery education solution.

Timothy Buttsworth, Maximilien Hallgren, Yongjia Zhang

We construct a rotationally invariant Ricci flow through surgery starting at any closed rotationally invariant Riemannian manifold. We demonstrate that a sequence of such Ricci flows with surgery converges to a Ricci flow spacetime in the sense of [32]. Results of Bamler-Kleiner [8] and Haslhofer [29] then guarantee the uniqueness and stability of these spacetimes given initial data. We simplify aspects of this proof in our setting, and show that for rotationally invariant Ricci flows, the closeness of spacetimes can be measured by equivariant comparison maps. Finally we show that the blowup rate of the curvature near a singular time for these Ricci flows is bounded by the inverse of remaining time squared.

R. Pfeifer, Y. Kalbas, R. Coimbra et al.

Yaoxi Liu, Ge Yang, Guanghui Zhu et al.

Abstract Background The current surgical treatment of choice is the combination surgical technique, involving tibial intramedullary fixation to maintain the mechanical axis and mechanical stability of tibial pseudarthrosis. In traditional combined surgery, the Williams rod is often used. Long-term intramedullary fixation of the foot and ankle will affect the ankle joint function of children. The intramedullary rod is relatively shorter due to the growth of the distal tibia. In addition, there are some complications such as epiphyseal bone bridge and high-arched foot. The use of a telescopic intramedullary rod may avoid these complications. Purposes To investigate the initial effect of the “telescopic rod” in a combined surgical technique for the treatment of congenital pseudarthrosis of the tibia in children. Methods A retrospective study including 15 patients with Crawford type IV CPT who were treated using a combined surgical technique and the telescopic rod from January 2017 to May 2018. The average age at the time of surgery was 43.3 months (16–126 months). Of the 15 patients, 7 had proximal tibia dysplasia and 12 exhibited neurofibromatosis type 1. The combined surgical technique using the telescopic rod included the excision of pseudarthrosis, intramedullary rod insertion, installation of Ilizarov’s fixator, tibia-fibular cross union, and wrapping autogenic iliac bone graft. The incidence of refracture, ankle valgus, tibial valgus, and limb length discrepancy (LLD) in patients were investigated. Results All patients achieved primary union with an average follow-up time of 37.3 months (26–42 months). The mean primary union time was 4.5 months (4.0–5.6 months). Nine cases showed LLD (60%), with an average limb length of 1.1 cm (0.5–2.0 cm). Ankle valgus, proximal tibial valgus, telescopic rod displacement, and epiphyseal plate tethering occurred in 1 case (6.6%) (18°), 3 cases (20%) (10°, 5°, and 6°, respectively), 6 cases (40%), and 2 cases (13%), respectively. There were no refractures during the follow-up periods. Conclusion Although there are complications such as intramedullary rod displacement while using the telescopic rod in a combined surgery, the primary healing rate of congenital pseudarthrosis of the tibia in children is high.