Candido is a rambunctious 2-year-old boy who loves to play and run around with his three older sisters. He is so energetic, in fact, that it was not until a bad fall that required an emergency room visit and x-ray imaging did his family learn that he was born with a rare bone defect called congenital pseudarthrosis of the tibia or CPT.
CPT is a rare condition that affects one in 250,000. It causes the tibia, or shin bone, to not develop normally. If left untreated, CPT leads to pain, limb deformity, and leg length inequality. In Candido's case, the middle of his left tibia had a fibrous connection instead of normal bone, making his leg susceptible to fracture. Candido broke his tibia in a simple fall and the bone never healed despite months of casting, leaving him with a deformed and painful leg.
The family was referred to the Orthopedic, Sports Medicine and Spine Institute at Nicklaus Children's where they met with Dr. Daniel Ruggles, an orthopedic surgeon with expertise in treating children with limb deformities and lengthening procedures.
CPT is challenging to cure, and traditional treatment has included amputation in failed cases of CPT. Thanks to advances in orthopedic techniques and limb salvage programs like the one at Nicklaus Children's, Dr. Ruggles was able to reconstruct Candido's leg through a complex, state-of-the-art surgery using internal and external fixation.
“Our ultimate goal in CPT is restore a child to normal function. To run, play, and function normally requires restoring the leg bones strength and ability to grow and heal.” said Dr. Ruggles.
"The surgery involved removing the abnormal fibrous tissue, stabilizing the bone, and creating an environment that will promote growth of a straight and strong new tibia. Stability is provided by placing a rod inside the bone simultaneously with a circular external fixator," said Dr. Ruggles.
The procedure also requires specialized bone grafting techniques, using Candido's own autograft bone cells combined with specialized synthetic bone-enhancing material called BMP (bone morphologic protein).
Within a month after his surgery, Candido was already running after his sisters. His mother, Shakira, says she is forever grateful to Dr. Ruggles and the team at Nicklaus Children's for making this experience a positive one.
“I was so worried to hear he needed surgery and a rod in my baby's leg. Thanks to this amazing team, my son didn't skip a beat and now he is doing better than he was before," she said.
Candido had his external fixator removed four months after surgery and it is possible he may need and procedure in the future to equalize his leg lengths. But in just a few months, Candido will be able to run, be active and even play sports just like his peers.