Congenital Pseudarthrosis of the Tibia (CPT) – Treatment at the Paley European Institute
A healing bone: effective CPT treatment for children without compromise. A cross-union protocol with 100% success rate, intramedullary stabilization, and rehabilitation starting from the very first days.
What are dysplasias and musculoskeletal disorders?
Dysplasias and congenital disorders of the musculoskeletal system are conditions in which the normal development of the musculoskeletal system is disrupted during fetal life or becomes apparent in early childhood. They encompass a wide spectrum of conditions—ranging from abnormal joint structure, through disorders of bone growth and mineralization, to rare congenital defects leading to limb deformities. The common thread among these conditions is their progressive nature: if left untreated, they eventually lead to increasing instability, pain, limb shortening, and impaired musculoskeletal function.
Early diagnosis and comprehensive treatment at a specialized center are crucial for the prognosis—especially in children, whose skeletal systems are still developing, and where timely treatment can prevent permanent deformities and amputation.
What is CPT?
Congenital pseudarthrosis of the tibia is a rare, serious orthopedic condition in which the tibia undergoes abnormal bending and subsequently a pathological fracture. At the site where natural bone healing should occur, instead of a permanent bony union, a pathological, mobile joint—known as a pseudarthrosis—forms. This mobility is completely abnormal and should not be present in healthy bone.
CPT occurs in 1 in 190,000 people and affects both girls and boys. The condition most often becomes apparent in early childhood, and an acute fracture usually occurs before the age of 2.
Association with Neurofibromatosis
Nearly half of children with CPT also have neurofibromatosis—some of them have neurofibromatosis type 1 (NF1, von Recklinghausen disease). This is important diagnostic information, as the co-occurrence of NF1 affects the choice of treatment and the prognosis.
How to Recognize CPT? Symptoms and Diagnosis
The first symptoms of CPT may appear at birth or during a child’s first few years of life. Look for the following:
visible curvature of the tibia (characteristic deformity of the shin)
pathological bone fracture without apparent trauma
instability of the lower limb
leg shortening
chronic pain in the lower leg
increasing difficulty walking
Diagnosis relies primarily on imaging studies. X-rays form the basis of the evaluation, allowing for the assessment of the absence of a bone bridge and the presence of fibrous tissue between the fragments. In more complex cases, computed tomography (CT) or magnetic resonance imaging (MRI) is performed. The Paley European Institute also conducts a detailed differential diagnosis to determine whether a pseudoarthrosis is a congenital defect, a complication of an injury, or part of a broader disease syndrome.
Why is early diagnosis crucial?
The older a child is at the time of diagnosis, the more difficult treatment becomes, and the risk of failure increases. If the fracture occurs before the age of 4, the prognosis is more serious—the risk of treatment failure increases, and in extreme cases, amputation of the limb may be necessary. Early intervention helps halt the progression of the deformity and avoid the most severe consequences of the disease.
Stages of CPT Treatment
Before the break
Objective: The objective is to protect the bone from pathological fractures and to limit the progression of deformity.
Until the fracture occurs, treatment involves immobilizing the limb with a special brace that covers the knee and thigh
After a fracture—surgical treatment
Once a fracture occurs, surgical intervention is necessary. The standard treatment includes:
- excision of pathological tissue at the site of the pseudoarthrosis
- bone graft
- intramedullary bone stabilization
Rehabilitation (Healing)
Objective: Gradual loading of the implant and learning to walk
Early mobilization: Immediate implementation of a globally unique, safe, and controlled implant loading protocol that accelerates osseointegration
Interface protection: Gradual increase in pressure and controlled intensification of exercises under the supervision of a physical therapist to prevent implant loosening and stoma damage
Functional Training: Learning to Use a New Prosthesis Safely and Restoring Proper Movement Patterns
Long-Term Care (Term)
Goal: Return to full activity and lifelong follow-up
Advanced Gait Training: Structured Improvement of Functional Mobility and Movement Dynamics
Social Reintegration: Support for Returning to Professional, Social, and Sports Activities (Para-Sports)
Lifetime Follow-Up: Regular monitoring of the implant's condition, prevention of complications, and lifelong prosthetic care
Psychological Adaptation: Ongoing support to help individuals fully realize the potential of new mobility and improve their quality of life
CPT Treatment Methods
(What we use—tools and techniques)
Cross-Union Protocol
The most effective technique available for achieving bone union.
Success Rate at the Paley European Institute: 100%
It involves creating an additional bony bridge between the tibia and the fibula.
Intramedullary stabilization
An intramedullary nail stabilizes the bone from the inside.
It minimizes the risk of a repeat fracture.
It allows for controlled loading of the limb during the healing process.
Bone graft
A biological material that stimulates bone regeneration.
It fills the cavities left after the removal of diseased tissue.
It accelerates the process of fusion and integration of bone fragments.
Limb lengthening
Correction of limb shortening resulting from CPT.
Conducted using methods consistent with the Paley Institute’s protocols.
May be used once a stable bond has been achieved.
Our Doctors Meet the Paley European Institute team
Your most frequently asked questions
This is a rare orthopedic condition in which the tibia becomes bent and suffers a pathological fracture, and instead of bone union, a pathological, mobile joint—a pseudoarthrosis—forms at the fracture site. The condition affects 1 in 190,000 children.
The first sign is often a visible bend in the shin or a spontaneous fracture without any apparent trauma. This may be accompanied by limb instability, leg shortening, difficulty walking, and chronic pain. Symptoms usually appear before the age of 2.
Yes. Nearly half of children with CPT also have neurofibromatosis—some of them have neurofibromatosis type 1 (NF1). That is why the diagnosis of CPT always includes an evaluation for NF1.
Until the fracture occurs, a brace covering the knee and thigh is used to protect the bone from breaking. Once the fracture has occurred, surgical treatment is necessary. Without surgery, it is not possible to achieve a permanent union.
Cross-union is an advanced surgical technique that involves creating an additional bony bridge between the tibia and fibula, which allows for stable union even in the most difficult cases. The success rate of this method at our center is 100%.
The sooner, the better. A fracture occurring before the age of 4 is associated with a poorer prognosis and a higher risk of treatment failure. Early diagnosis and prompt initiation of treatment—first with orthoses, followed by surgical treatment after the fracture—significantly improve outcomes.
Yes, rehabilitation is an integral part of treatment. Preoperative and postoperative physical therapy helps restore muscle strength, a normal gait pattern, and full limb function. Without rehabilitation, the results of the surgery would be incomplete.