home Audience 6 Formation and treatment of pseudarthrosis. Pseudarthrosis after a fracture Formation of a pseudarthrosis after a fracture of the radius

Formation and treatment of pseudarthrosis. Pseudarthrosis after a fracture Formation of a pseudarthrosis after a fracture of the radius

The process of bone fusion is then characterized by the formation of “bone callus,” which is a mass that does not have a clear shape or structure (high friability). To make bone fusion more accurate, doctors use various methods - for example, applying plaster, using metal plates or knitting needles to reliably align fragments/splinters, traction of skeletal bones, and so on. But even with such a competent approach to the treatment of fractures, there are cases when the tubular bone simply does not heal. The result is a smoothing of the contacting edges of the bone and the formation of a false joint - in medicine this formation is called pseudarthrosis.

In general, the complication of fractures in question is considered to be quite common - if a patient is diagnosed with a closed bone fracture, then doctors predict the development of a pseudarthrosis with a probability of 5-11%, but with open ones - 8-35%. Most often, the pathology in question occurs with a fracture of the femoral neck, a little less often - with a fracture of the radius, and if this pathology is congenital - on the lower leg.

Causes of pseudarthrosis

The appearance of congenital pseudarthrosis is always associated with some intrauterine pathology of the fetus. This type of pathological condition in question is, in fact, quite rare - only one case per 190,000 newborns. The reasons for the birth of a baby with a pseudarthrosis can be:

fibrous dysplasia;
amniotic band;
embryonic defect of blood vessels due to their underdevelopment.

Acquired false joints are a common complication of fractures and their causes are clearly defined by doctors:

consequences of surgical interventions - for example, incorrect fixation of bone fragments when there is no required joint strength, or their resection;
purulent complications of fractures;
improper treatment of fractures - for example, the patient began to load the limb too early, or the doctor was forced to change the plaster several times during the treatment period;
improper immobilization of the injured limb with plaster, violation of the rules of skeletal traction, early removal of the apparatus for fixing fragments;
some diseases that can lead to disruption of normal bone regeneration and metabolism - tumor cachexia, general intoxication of the body, pathologies of the endocrine system.

In addition to all of the above, several provoking factors can be identified that can also lead to the appearance of acquired pseudarthrosis:

Classification of false joints

Depending on what was the provoking factor or the true cause of the condition in question, they distinguish congenital And acquired pseudarthrosis. If we consider this pathology from the nature of the damage, then only gunshot and non-gunshot pseudoarthrosis will be distinguished. But the classification of false joints according to their clinical manifestations is more detailed:

Forming false joint. Occurs at the end of the period necessary for normal bone fusion. helps to identify clear boundaries of the fracture gap and callus. The patient complains of constant nagging pain in the area of the formation of the false joint, and when trying to feel it, he indicates an increase in the intensity of pain.
Fibrous pseudarthrosis. The doctor will clearly diagnose the presence of fibrous tissue located between the bone fragments, and the result of the x-ray will be a clearly defined gap between them. With such a false joint, if it forms in the area of the joints, the mobility of the latter becomes sharply limited.
Necrotic pseudarthrosis. It often occurs after gunshot wounds, but can also occur with fractures if there is a high probability of developing bone necrosis. Doctors often diagnose such purulent pseudarthrosis with injuries to the neck of the talus and femur or the middle part of the scaphoid.
Pseudoarthrosis of bone regenerate. It appears when the osteotomy of the tibia is incorrect, if the doctor violated the rules for stretching or performed poor-quality fixation when using special equipment to lengthen the segments.
True pseudarthrosis (neoarthrosis). Most often it develops on single-bone segments with their excessive mobility. Such pseudoarthrosis is characterized by the formation of fibrous cartilaginous tissue with areas of hyaline cartilage at the edges of bone fragments. A formation appears around the debris, which in its composition and appearance resembles a periarticular bursa.

According to the method of formation and intensity of bone formation, the pathological condition in question is classified as follows:

hypertrophic pseudarthrosis - bone tissue begins to grow specifically at the ends of the damaged bone;
normotrophic pseudarthrosis - no growths are found on bone fragments;
atrophic pseudarthrosis - insufficient blood supply, insufficient bone formation are clearly defined, osteoporosis can be diagnosed.

In addition, pseudarthrosis can be uncomplicated - a condition in which there is no infection or the appearance of pus at the site of pseudarthrosis formation. But in some cases, doctors diagnose “infected pseudarthrosis,” which means that a purulent infection has occurred. In this case, the patient will develop fistulas and cavities of different sizes at the site of bone injury, from which purulent contents are periodically released. Most often, such false regulations contain shell fragments or metal fasteners.

Symptoms of pseudarthrosis (pseudoarthrosis)

The signs of the pathological condition in question are quite specific, so diagnosis is not difficult. The most pronounced symptoms of pseudarthrosis include:

an increase in the amplitude of movements, a change in their direction, which cannot be called characteristic of the limb;
A large swelling with clear boundaries forms slightly below the fracture site;
atypical mobility of those parts of the body that normally should not have movements;
changes in the functions of joints located close to the fracture site;
the muscles of the limb lose their characteristic strength - with a false joint, the patient cannot squeeze his fingers or lift a light object;
dysfunction of a broken limb.

Diagnostic measures

A completely informative diagnostic method for suspected pseudarthrosis formation is the usual one. Computed tomography is performed extremely rarely, only in cases of severe fracture and unclear pseudarthrosis.

Studying x-rays for pseudarthrosis helps the doctor identify:

X-ray images can only identify and confirm the presence of a pseudarthrosis, but to determine the degree of bone formation and diagnose the specific form of the pathology in question, the patient will be prescribed a radioisotope study.

Treatment of pseudarthrosis

The main method of treatment for the pathological condition in question is surgery.. The goal of such treatment is to restore the continuity of the broken bone and only then doctors take measures to eliminate the deformities. Treatment tactics are selected individually, because everything depends on the specific clinical case and the characteristics of the patient’s body.

The false joint is eliminated by therapeutic measures of general and local action.

General therapeutic measures

By this term I mean measures that are aimed at increasing muscle tone, normalizing blood circulation directly at the site of formation of the pseudarthrosis; doctors try to preserve the functionality of the damaged lower or upper limb as much as possible. To achieve these goals, the patient is prescribed various physiotherapeutic procedures, massage and a set of exercises based on the treated gymnastics.

Local treatment

It involves performing an operation, the purpose of which is to create favorable conditions for the fusion of bone fragments. While working with the patient, the surgeon not only restores the normal shape of the bone by bringing together and connecting the fragments, but also ensures normal blood circulation in this place. Preventive measures that are aimed at preventing the addition of infection and the development of purulent inflammation are considered mandatory in this case.

Local treatment is carried out using different methods:

bone grafting;
compression-distraction osteosynthesis;
stable osteosynthesis.

Specific local treatment tactics are selected depending on the type of pseudarthrosis. For example, if it has a hypertrophic form, then a compression-distraction device will simply be applied to the limb. But with atrophic pseudarthrosis, bone grafting will have to be performed.

Compression-distraction osteosynthesis3

This treatment method involves the use of special devices that will ensure comparison of bone fragments. The doctor must ensure complete immobility of the injured limb, and already in this state, the use of a device begins that will bring the bone fragments closer and align them. It is compression-distraction osteosynthesis that helps specialists eliminate shortening and/or deformities of the limbs.

Sustainable osteosynthesis

This method of treating pseudarthrosis involves the use of metal parts (plates or rods) that will ensure the healing of the damaged bone. To apply them, the surgeon will have to completely expose the bone at the fracture site - this operation is performed under general anesthesia.

If a patient is diagnosed with hypertrophic pseudarthrosis, then bone grafting surgery is not required, but in the case of treatment of atrophic pseudarthrosis, it is necessary.

Bone grafting

It is carried out rarely; before the operation it is necessary to eliminate any inflammatory processes and make sure that there are no scar changes. If there are any, then first the purulent inflammation is cured and the cicatricial changes are excised. Bone grafting surgery can only be performed 8 months after the specified treatment, but doctors usually wait 12 months.

If a pseudarthrosis is treated, the affected limb must be immobilized (immobilized) for quite a long time. As soon as doctors allow movement, the patient must undergo a course of rehabilitation therapy. As part of this rehabilitation period, massage and physical therapy courses, physiotherapeutic procedures are carried out, and sanatorium-resort treatment may be prescribed.

In general, the result of such complex treatment is usually excellent - in 72% of cases, patients were discharged home with completely restored functions of the injured limb.

Pseudarthrosis is a pathology that is very easy to diagnose, so doctors recommend simply undergoing a full course of treatment, which will be prescribed by the attending physician - treatment in any case will be timely.

Tsygankova Yana Aleksandrovna, medical observer, therapist of the highest qualification category

A false joint or pseudarthrosis develops due to improper fusion of bone fragments during a fracture. Under normal circumstances, after a fracture, bones heal by forming pliable, shapeless bone tissue. It helps to fuse 2 bone fragments and restore its integrity.

In medicine, many special treatment techniques are used, for example, applying plaster, connecting bone fragments using metal plates, performing skeletal traction and other manipulations for proper fusion of bones during a fracture. But if the bone fragments, due to some reason, do not heal properly, after some time the edges of the bones that are in contact with each other are rubbed in and smoothed. This is how a false joint is formed. Sometimes there is the development of a thin layer of cartilaginous tissue on the surface of the fragments that are in contact, or the accumulation of fluid. The formation of a certain articular capsule around the pathological fusion is often observed.

Such abnormal fusions are divided into several categories: congenital, traumatic and pathological. Based on the clinical and radiological picture, we can distinguish:

A false joint that is forming. It develops after a period of bone fusion. The features of this pathology are: pain in the fracture site, pain on palpation and during physical activity. Fluoroscopy shows the specific fracture lumen and periosteal callus.
Fibrous false joint - dense fibrous tissue appears between the bone fragments, the joints move normally, but the x-ray shows a narrow gap after the fracture.
A necrotic false joint occurs with gunshot injuries. This disrupts blood circulation. Or it can occur after a fracture, if there is a predisposition of the bones to the formation of necrosis.
A false joint of bone regenerate is an abnormal formation that appears as a result of osteotomy due to excessive stretching or improper fixation during medical procedures to lengthen segments.
A true pseudarthrosis is formed mainly on single-bone segments in places of pathological mobility. The bone fragments are polished, soon they are covered on top with fibrous cartilage tissue, and a gap appears between them, in which fluid accumulates. A cavity with defective contents is formed near the ends of the fragments.

According to the presence of infections and pus, uncomplicated false joints are divided into infected pathological formations.

Based on the stages of osteogenic activity, they divide:

Hypertrophic formations - with this type, bone tissue grows at the ends of the fragments. This phenomenon occurs in people with constant pressure on the limb or with reduced motor activity of bone fragments.
Avascular false formations - with this form, blood circulation in the joints is impaired, a violation in bone formation is visualized, and osteoporosis of the fragments is formed.

Why does it form?

The main causes of pseudarthrosis, which provoke the appearance of pathological fusion, are diseases accompanied by disruptions in metabolism (diseases of the endocrine system, oncological diseases), complications after surgery (weak fixation), improper management of postoperative therapy (early loads on the limb, early removal of fixators). Other factors in the development of pathology are errors in drug therapy and purulent formations. The reasons for the formation of pathology are as follows:

impaired blood circulation in the area of fragments;
increased clearance between fragments;
getting into the gap between fragments of soft tissue;
incorrect location of fragments after matching bones touching each other.

There are other reasons for the appearance of pseudarthrosis:

osteoporosis;
damage to bone tissue during surgical treatment;
lack of formation of a blood clot between fragments;
the body's reaction to metal fixation devices;
the presence of a foreign body between the fragments;
excessive number of fragments;
reaction to taking certain medications after a fracture (hormones, anticoagulants);
the presence of any other tissue injuries (burns).

Symptoms of the disease

The main symptoms and signs of the onset of pathology are excessive mobility of some joints, which during normal development should not move this way. This phenomenon can be almost invisible, or, on the contrary, intensely expressed. For example, there are cases in medical practice when a sick person was able to rotate a limb 360 degrees in those areas where pseudarthrosis had formed. Changes in the muscle strength of the joint are observed, and shortening of the limb up to several centimeters is diagnosed.

Normal motor activity of the affected limb is disrupted. This phenomenon can be observed especially clearly with anomalies in the lower limb - the leg turns under, the person loses the ability to stand on it. The patient needs support with a cane or crutches.

Therapy methods

The main stages of therapy after a fracture include restoring bone continuity. Getting rid of the resulting deformities makes it possible to restore the normal functioning of the limb. Treatment is carried out by a doctor according to the degree of damage. In addition to the basic methods (fixators, special devices, bone grafting), physiotherapy, general strengthening of the body, massage, and normalization of blood circulation are performed.

Pseudarthrosis after a fracture (neoarthrosis) is the most common and severe disease of the musculoskeletal system. It occurs as a complication in 15% of limb fractures due to abnormal fusion of the bone parts during the fracture. Pseudarthrosis after a fracture is especially common with lesions of the lower leg bones.

Reasons for education

When the diaphysis is destroyed, specialists fasten its halves with metal staples, stretch it and perform other measures for high-quality bone fusion. Under normal conditions, a broken bone is helped to heal by "" - an amorphous growth of plastic connective fibers that connects the separated parts. But if they do not connect in the proper way, then over time the edges of the fracture smooth out and form a pseudo-joint. Often there is the growth of a thin layer of fibrosis on the surface of contacting fragments. All this is placed in a synovial bursa, mobile and painless.

Important! The main reason for the formation of a false joint is insufficient fixation of broken bone fragments.

Varieties

Pseudarthrosis, depending on the cause, can be congenital, traumatic or pathological.

Based on clinical radiology, joints are:

Pseudoarthrosis - formed as a result of incorrect fusion, characterized by pain in the fracture bursa, pain during movement and palpation. The X-ray clearly shows the fracture gap and the "".
Fibrous - fibrogenesis predominates between the parts of the broken bone. The mobility of diarthrosis is normal, but fluoroscopy reveals a thin lumen at the site of fracture.
Necrotic. They arise due to circulatory disorders after gunshot injuries or fractures of the diaphysis, which is predisposed to the appearance of necrosis.
Regenerative - painful changes due to osteotomy from increased stretching or inaccurate fixation during medical lengthening measures.
True neoarthrosis. Formed on single-bone sections in the area of traumatic mobility. Fragments of the diaphysis rub and grind, over time they become overgrown with fibers, and at the fracture a gap is rubbed into which liquid flows.

Depending on the presence of purulent infection, uncomplicated pseudarthrosis and infected pseudoarthrosis are distinguished.

The stages of dynamics are distinguished:

Hypertrophic - the tops of the fragments are overgrown with fibrosis. Due to prolonged compression on the limb or with reduced dynamic activity of fragments.
Avascular - impaired hemodynamics in diarthrosis leads to pathological metamorphosis in osteogenesis, creating osteoporosis of fragments.

The following subtypes of neoarthrosis are common according to location:

Pseudarthrosis after hip fracture. Most often found in older women. This is due to progressive osteoporosis during menopause. Treatment is effective only surgically - the degenerative surfaces of the newly formed diarthrosis are removed and the bones are re-aligned, fixing them.
False joint after. When the fracture is not fused, it causes mainly aesthetic inconvenience - it does not always cause pain.
False joint after a fracture of the tibia - in the area of unfused fracture of the fibula.
The false joint after a fracture of the radius is localized in the forearm. It is often the basis of radial clubhand.
A false joint after a fracture of the humerus - without axial load - has a greater effect on the functionality of the arm than on well-being.
A false joint after a jaw fracture leads to a malocclusion and difficulty eating.
Pseudojoint of the ankle - complicated by twisting of the foot, instability, pain and swelling in the ankle diarthrosis.

Causes of neoarthrosis

One group of unnatural fusions occurs due to metabolic problems, complications after clinical procedures, and illiterate postoperative support (premature loads, removal of plaster). The other group is based on errors in medication support and purulent complications. The basics of the disease are:

impaired hemodynamics at the site of fracture;
expanded gap between fragments;
penetration of parts of soft fibers into the lumen;
incorrect position of the diarthrosis parts after comparison.

There are other causes of neoarthrosis:

osteoporosis;
bone deformation during surgery;
body reaction to metal clamps;
the presence of a foreign particle between the fragments;
high number of fragments;
reaction to taking certain medications after a fracture;
influence of other tissue injuries.

Symptoms of the disease

The main signs of a pseudo-joint are the unnatural lability of diarthrosis, which normally cannot move like that. Such an ailment can be subtle and clearly expressed. The muscle strength of diarthrosis changes, shortening up to one inch is determined, the dynamism of the limb changes pathologically, which is especially noticeable with the disease in the lower extremities - the leg gets tucked in, the ability to stand on it disappears. The patient needs support on a cane or crutches.

In clinical practice, patients are known who are able to rotate the foot 360 degrees at the site of pseudojoint formation.

Treatment of pseudarthrosis

Today medicine has in its arsenal various methods of treating pseudarthrosis, but it is rarely done without surgery.

A personal approach is used to diagnose pseudarthrosis, since the potential for regeneration varies greatly among patients. Treatment of pathology is considered in a complex of information and associated diseases:

Without complications, with slow fusion - conservative techniques are applicable, correcting associated ailments, as well as shaping the substrate.
Surgical intervention is prescribed when the diagnosis of neoarthrosis is reliably determined. Today's technological diversity makes it possible for each patient to choose an individual support option.
Upon completion of the operation, a long recovery phase follows - it returns the affected diarthrosis to a healthy endurance of stress. For this purpose, a complex method of physiotherapy and physical therapy is used.

A false joint that is treated comprehensively heals faster. After all, it turns out to organize consistency that prevents relapses.

Conservative care

When a false joint forms, treatment after a fracture consists of taking medications that correct the painful transformations. Their effect is aimed at concomitant pathologies and at osteosynthesis itself:

Hormones are glucocorticoids administered by electrophoresis or injection. Their action inhibits degenerative changes that interfere with the growth of dense tissue. Associated diseases that interfere with the nutrition of the diaphysis and complicate the fracture are healed.
Drugs that have a positive effect on hemodynamics. They stimulate metabolism on the scale of small vessels, accelerating regeneration processes in the area of fracture.
Means that accelerate rehabilitation.

Conservative methods are not effective in all cases. Treatment of pseudarthrosis of the tibia and other large bones is not carried out using internal methods due to their ineffectiveness. Immobilization in this embodiment does not lead to the formation of a bone substrate capable of consolidating fractures.

The main method of assistance in such cases is surgical.

Surgical therapy

Radical elimination of pathology creates conditions for proper bone fusion. With all the variety of operations, similarities can be identified:

Resection of deformed tissues.
For secondary joining of fragments, the barrier in the form of connective tissue is removed.
The possibility of combining fragments is established (this method excludes strong tissue resorption).
Hypotrophies are corrected using the Ilizarov technology, which makes it possible to secure the diarthrosis to create a fusion zone.
After resection of tumors, separate fixation is performed.
The neck of the femur stands apart in the clinic of these pathologies - a false joint after a fracture of the femoral neck ends with a complete replacement of the hip diarthrosis.

Folk remedies

The surgical procedure for neoarthrosis is often recurrent. This is due to the biochemistry of osteopathology. When a pseudarthrosis has been operated on, treatment with folk remedies will help recovery.

Comfrey roots are best for regeneration and eliminating swelling. Pour vodka into the plant in a ratio of one to five and leave for three weeks. Take twenty-five drops three times a day.
Comfrey compresses are also effective. For three tablespoons of the plant, one and a half cups of boiling water, leave for half an hour and strain.
The following ointment helps perfectly with neoarthrosis: one onion, 50 g of vegetable oil, 20 g of spruce resin, 15 g of copper sulfate powder. Pour into a cup, stir and bring to a boil.

14.06.2013

False joint

False joint(synonymous with pseudarthrosis) is a variant of fracture fusion when, after twice the average period required for bone fusion, there are no clinical and radiological signs of fusion.

Pseudarthrosis is characterized by the presence of a number of clinical and radiological signs. The main ones are: pain, dysfunction of the injured limb, lack of radiological signs of strong fusion. In the picture below you can see what a false joint of the humerus looks like.

The main causes leading to the formation of false joints can be divided into general and local.

Common causes account for approximately 3.5% of all cases of false joint formation. This includes some congenital bone malformations (usually the lower leg and forearm) and a number of diseases that affect the process of callus formation and reduce the strength of the bone itself:

Osteoporosis;

Multiple and combined injuries;

Oncological diseases;

Endocrine diseases;

General nutritional disorders;

Intoxication;

Rickets;

Pregnancy.

Local causes account for approximately 96.5%, these are:

Technical errors during the operation;

Incorrectly applied plaster cast;

Premature removal of the plaster cast;

Unreasonable or incorrectly changed plaster cast;

Displacement of bone fragments in a plaster cast;

Early or incorrectly dosed load on the limb;

Wound infection;

Pathological fractures.

Combined injuries.

A combined injury is one when a bone fracture is combined with damage to internal organs or traumatic brain injury, or damage to large vessels and nerves.

A pathological fracture is a fracture that occurs from minor trauma or even without visible violence, against the background of previously changed bone (usually against the background of osteoporosis or tumor metastasis).

Load dosing. Usually, after removing the bandage and confirming the presence of fracture healing, an incomplete, gradually increasing load is prescribed. The joint is fixed with an elastic bandage. After removing the cast from the ankle joint for a fracture of the outer malleolus, it is recommended to walk on crutches with a gradual load on the leg. The load system is determined by the attending physician. And, only if the recovery period is favorable, walking with full weight bearing on the leg, supported by a cane, is allowed in the future. At this time, the joint is fixed with an elastic bandage.

What are the types of false joints?

By origin

1. Congenital pseudarthrosis. The cause of its formation is a congenital defect in the development of bone tissue, usually in the lower leg area. Such diseases are detected during the child’s first steps.

2. Traumatic false joints. Formed after bone fractures, often open or with combined trauma.

3.Pathological false joints. Formed against the background of a pathological fracture. A typical example of such a pseudarthrosis is the pseudarthrosis that occurs in old people.

According to the type of joint formed

1.Forming pseudarthrosis, the term delayed consolidation is sometimes used. Occurs after the average period required for healing of the fracture. Characterized by pain at the site of the fracture, which intensifies when it is felt or when moving the limb. The x-ray shows a clear fracture line against the background of a weak callus.

2.Tight false joint (synonyms - slit-like, fibrous). It is formed in a period twice as long as the average time for fusion of a particular bone. It is characterized by the formation of coarse scar tissue between the fragments, with the presence of a narrow gap between them and a pronounced bone callus. Pathological mobility is not expressed. The pain is often moderate and often not constant. The dysfunction is often moderate.

3.Necrotic pseudarthrosis. Occurs after open bone fractures, usually comminuted, accompanied by massive damage (crushing) of soft tissues. Or in places prone to the formation of necrosis of bone areas after a fracture (fractures of the femoral neck, talus of the foot or scaphoid bone of the hand). It is characterized by severe constant pain, soft tissue swelling, and severe dysfunction.

4. False joint of bone regenerate (destruction of callus). It is formed when there is excessive “stretching” of a bone segment, using an external fixation device or weights (skeletal traction). Depending on the specific situation, it may present with signs of a tight or necrotic pseudarthrosis.

5. True false joint (neoarthrosis) Forms most often in the area of the humerus or femur. It is characterized by more or less pronounced deformation and pathological mobility. Bone fragments are covered with scar tissue with areas of cartilaginous tissue, and a cavity filled with liquid is formed between them. The joint capsule is formed. In the presence of a large defect of bone tissue, a so-called “dangling false joint” is formed. Which is characterized by a complete loss of the ability to fix bone fragments. They begin to move completely independently of each other, dangle, the axis of the limb is completely lost.

According to the severity of callus

1.Hypertrophic pseudarthrosis. Pseudarthrosis with excessive callus. With relative stability of bone fragments. Moderate or minor pain syndrome, allowing patients to load the limb. The periarticular vascular network is relatively preserved.

2.Avascular pseudarthrosis. Formed against the background of severe malnutrition of bone fragments. It is characterized by more or less pronounced divergence of fragments, severe osteoporosis and mild callus. They are characterized by more or less pronounced deformation of the limb axis and pathological mobility. Severe dysfunction, persistent pain.

In relation to infection

1. Not complicated. Without obvious local and general signs of inflammation. More often formed and tight false joints.

2. Infected. Pronounced local signs of inflammation: redness, increased local temperature, the presence of soft tissue compaction. Moderately expressed general signs of inflammation: low-grade fever, sweating, malaise, severe pain and dysfunction. But no purulent focus is detected.

3. Complicated by purulent infection. Characterized by the presence of fistulas with purulent discharge. The presence of sequesters, foci of bone inflammation, foreign bodies. As a rule, it is a chronic, relapsing process.

Pathological mobility.

Mobility that occurs in an unusual location, outside a joint, throughout a segment of the limb. Accompanied by more or less pronounced deformation of the damaged area, a painful reaction when palpating and moving. Moderate or severe dysfunction.

Callus.

The process of bone fusion is complex and consists of several stages. The most important of which is the formation of callus. This is a long process: first, a scar bone callus is formed, then a cartilaginous callus, which eventually turns into bone callus. For the entire period of callus maturation, strong fixation of the fracture site is necessary. The severity and nature of the callus determine the outcome of treatment.

External fixation device.

Special structures capable of creating stability at the fracture site without intervention at the fracture itself. Therefore, the second name for such designs is devices for extrafocal osteosynthesis. The Ilizarov apparatus is most famous in our country.

Clinical picture of a pseudarthrosis. Main symptoms.

1. Persistent pain at the fracture site throughout the entire treatment period and after the period necessary for bone healing.

2. Deformation of the limb at the fracture site.

3.Pathological mobility. It can be expressed to varying degrees from barely noticeable to a “dangling joint”.

4. Impaired functions of support and walking. Unsteadiness when walking, possible “breaking” of the leg at the site of the false joint when walking. Uncertain gait, lameness.

5.Decreased muscle tone and strength in the injured limb.

6.Mobility in the joints located above and below the site of injury is limited.

7.Swelling of the parts of the limb located below the fracture site, bluish coloration of the skin of these parts.

8. Radiographs show the presence of a clearly defined fracture line, curvature of the limb axis, and displacement of bone fragments relative to each other. In the figure you can see what a false joint looks like on an x-ray.

Treatment of false joints

Treatment of false joints is only surgical. During the operation, scar tissue and altered areas of the bone are removed. The resulting defect is restored using bone transplantation. Fixation is carried out using a rod or plate. Often with the help of external fixation devices.

Tags: false joint
Description for the announcement:
Start of activity (date): 06/14/2013 11:42:00
Created by (ID): 6
Key words: Pseudarthrosis, pseudarthrosis, fracture fusion, bone fusion, radiological, fusion, pain, humerus, tibia, forearm, callus formation process, plaster cast, removal of the plaster cast, Displacement of bone fragments in the plaster cast, load on the limb, Pathological fracture, osteoporosis, load dosing, femoral neck fracture in the elderly, x-ray, fracture line, callus, fractures of the femoral neck, talus of the foot, scaphoid bone of the hand, constant pain, soft tissue swelling

False joint(pseudoarthrosis; synonym for pseudarthrosis) - a violation of the continuity of the bone with the development of mobility unusual for this part of it. There are congenital and acquired false joints. It is believed that the basis of congenital false joints is an intrauterine disorder of bone formation. Acquired pseudarthrosis in most cases is a complication of bone fractures caused by impaired fusion of fragments. Acquired false joints are divided into hypertrophic, atrophic and normotrophic. For the formation of a false joint, significant divergence of bone fragments after their reposition, insufficient immobilization or its premature termination, excessively early load on the damaged segment of the limb, suppuration in the fracture zone, and local disruption of the blood supply to bone fragments are important. Less commonly, false joints form after orthopedic bone surgery, such as osteotomy, and with pathological fractures.

The gap between the bone fragments that form the false joint is filled not with callus, but with connective tissue. With the long-term existence of a false joint, mobility in it can increase, neoarthrosis (a new joint) is formed, in which there is a capsule, an articular cavity containing synovial fluid, and the articulating ends of the bone are covered with cartilage.

A characteristic symptom of false joints is pathological mobility of the bone in an unusual part of it, most often along the diaphysis. The degree of this mobility varies: from barely noticeable to movements with large amplitude. In some cases, clinical symptoms may be mild or absent (for example, with a pseudarthrosis of one bone of a two-bone segment). Axial load during walking with a pseudarthrosis of the lower limb usually causes pain. Congenital false joints, for example of the bones of the lower extremities, most often the lower leg, appear when the child begins to walk. They are characterized by greater pathological mobility than with acquired false joints.

When making a diagnosis, in addition to clinical data, they are guided by the period normally required for healing of this type of fracture. After this period has expired, they speak of a slowly healing or non-union fracture, and after a double or longer period - of a pseudarthrosis. X-ray examination is crucial for the diagnosis of pseudarthrosis. Radiographs are necessarily performed in two mutually perpendicular projections; sometimes additional oblique projections are used, as well as tomography. The main radiological signs of a false joint are: absence of callus connecting the ends of both fragments; rounding and smoothing of the ends of fragments or their conical shape (atrophic false joint); fusion of the bone marrow cavity at the ends of fragments (development of the endplate). Often the end of one fragment has a hemispherical shape and resembles an articular head, while the end of the other is concave like a glenoid cavity. In this case, the joint space (neoarthrosis) is clearly visible on radiographs. Thickening of bone fragments in the area of the pseudarthrosis gap, uneven contours of the gap itself, and its small width are characteristic of a hypertrophic pseudarthrosis. To assess the intensity of bone formation processes in the area of the pseudarthrosis, radionuclide testing is used.

Treatment of pseudarthrosis is mainly surgical and depends on the type and location of the pseudarthrosis. Various methods of osteosynthesis are used, usually in combination with bone grafting.