A baby born with a rare malformation in the tibia saves his leg thanks to an autotransplant


Isaac, the 23-month-old baby whose leg was saved.

Isaac, the 23-month-old baby whose leg was saved.
EFE

Doctors at the HM Nens Hospital in Barcelona have saved the right leg of a 23-month-old baby who was born in Parla (Madrid) with a congenital pseudoarthrosis of the tibia, a very rare malformation that in 50% of cases ends with the amputation of the limb.

The medical achievement has been achieved by Francisco Soldado, head of the Pediatric Orthopedics and Traumatology Surgery Service of the HN Nens Hospital, who gave the baby a vascularized transplant of the periosteum of the healthy leg that will allow the damaged bone to join and, as reported by the hospital, “normalize the child’s childhood.”

Isaac was born in May 2019 in the Madrid town of Parla and his life passed like that of any other baby until he was seven months old, when, as explained by his mother, Melisa Carmona, “one day he was playing with his uncle and we heard a crack We saw that something was wrong and we took him to the local hospital, from which we were referred to a larger one. There, they did an MRI and they told us he had a fissure“.

After weeks of tests, splints and casts, the child did not improve and each time he cried and complained more So the mother looked for information on the internet and contacted Dr. Soldado, who was interested in the baby’s situation and diagnosed him with a congenital pseudoarthrosis of the tibia.

The doctor explained that the bone had a dysplasia (an anomaly in its formation and development) that would have prevented it from playing and practicing sports or physical activity normally, since with growth, it would have curved until it broke.

This malformation ends with the amputation of the leg in 50% of cases., because the break does not solidify well and tends to repeat itself until it becomes an irreparable evil “, explained Soldado, who has assured that” until recently, congenital pseudoarthrosis was a problem without a solution, but fortunately, today it has it in the 90 % of the cases”.

Soldado presented the case to the HM Obra Social Nens Foundation, which has taken over the case of Isaac, who suffered from a congenital cystic pseudoarthrosis, a more complex variety and whose prognosis is always “more uncertain”.

The surgical intervention consisted of cleaning the bone and performing a vascularized transplant of the periosteum -membrane that covers the bone and contains an abundant amount of stem cells- from the healthy leg to the affected area, joining the arteries and veins through microsurgery.

In this way, the microsurgically transplanted healthy tissue will revitalize the damaged tibia, regenerating it and promoting absolutely normal growth and development, according to the specialist, who has highlighted that HM Nens is the only hospital in Spain and one of the few in the world to treat congenital nonunion with this technique.

Soldado began using this technique in 2015 and, despite the fact that it is a problem that is rarely seen, he has already operated on 21 children.

“For me, it is a great satisfaction to be able to help these children to lead a normal life and that, in many cases, would not be possible without the contribution of the HM Obra Social Nens Foundation, which supports them without hesitation, “concluded the traumatologist.

It is estimated that congenital nonunion affects one child in 200,000 live births worldwide and although it is increasingly common to detect it at birth or a few days later, it can occur throughout the first decade of life.

Although its origin is unknown, some theories associate 50% of cases with neurofibromatosis and others link it to possible uterine trauma, birth fracture, generalized metabolic disorders or vascular malformations.

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