Pseudoarthrosis is a pathological condition accompanied by a violation of the continuity of the tubular bone and the appearance of mobility in unusual parts of it. It often has a low-symptomatic course, manifested by the presence of mobility in an unusual place and pain when resting on the affected limb. It is diagnosed according to the results of an objective examination and X-ray examination data. Treatment is mainly surgical. Osteosynthesis surgery is performed, and if it is not effective enough, bone grafting is performed.
ICD 10
M84.1 Non-fusion of the fracture [pseudarthrosis]
Causes
Acquired pseudoarthrosis (false joint) is a complication after a bone fracture caused by a violation of the process of fusion of fragments. The probability of developing pathology increases with the introduction of soft tissues between fragments, a significant distance between bone fragments, insufficient or early immobilization, premature loading, local blood supply disorders and suppuration in the fracture area.
The risk of pathology increases with metabolic disorders, endocrine and infectious diseases, circulatory disorders due to shock or blood loss, multiple fractures, severe combined trauma, violations of innervation in the fracture zone. The cause of the development of congenital false joints is a violation of nutrition and innervation of the corresponding segment of the limb in the prenatal period.
Pathanatomy
With acquired pseudoarthrosis, the gap between the bone fragments is filled with connective tissue. The structure of long-existing false joints is gradually changing. The ends of the fragments are covered with cartilage, become more mobile. In the area of the gap, an articular cavity covered with a capsule and filled with synovial fluid is formed. In congenital pathology, the affected area is filled with not fully formed bone tissue, which cannot withstand the load on the limb.
Classification
By etiology:
- purchased;
- congenital.
By type:
- fibrous false joints without loss of bone substance;
- true (fibrous-synovial);
- false joints with a bone defect (loss of bone substance).
By type of formation:
- normotrophic;
- atrophic;
- hypertrophic.
Symptoms
The acquired variant of the pathology occurs at the site of the fracture, accompanied by more or less pronounced mobility of the bone in an unusual place. If pseudoarthrosis forms on one of the two bones of the limb segment (for example, on the radius with an entire ulna), symptoms may be absent or weakly pronounced. Palpation, as a rule, is painless, a significant load (for example, reliance on pseudoarthrosis of the lower limb) is usually accompanied by pain. Congenital pseudoarthrosis is characterized by more pronounced mobility. Pathology is revealed when a child learns to walk.
Diagnostics
The diagnosis is made by an orthopedic traumatologist on the basis of anamnesis, clinical and radiological picture, as well as the time that has elapsed since the injury. If the average time required for the fusion of this type of fracture has passed, they speak of delayed consolidation. In the case when the average period of fusion is exceeded by two or more times, pseudoarthrosis is diagnosed. Such a division in traumatology and orthopedics is rather conditional, but, at the same time, it is of great importance when choosing treatment tactics. With slow consolidation, there is still a chance for fusion. When forming a false joint, independent fusion is impossible.
To confirm the diagnosis, radiography is performed in two (direct and lateral) projections. In some cases, radiographs are made in additional (oblique) projections. The images reveal the absence of a callus, smoothing and rounding of the ends of bone fragments, the appearance of a closure plate at the ends of fragments (closure of the cavity in the center of the tubular bone). On the X–ray of the atrophic false joint, the conical narrowing of the ends of the bone fragments is determined, on the image of the hypertrophic false joint, the thickening of the ends of the fragments and the uneven contours of the gap are determined. With a true false joint, the end of one fragment becomes convex and the other concave.
Treatment
Conservative therapy is ineffective. The operation of choice is a low-traumatic compression-distraction osteosynthesis (application of the Ilizarov apparatus). In the absence of a result, bone grafting or resection of the ends of bone fragments with their subsequent elongation is performed. Treatment of congenital pseudoarthrosis is complex, includes surgery in combination with physio- and drug therapy aimed at improving the nutrition of tissues in the affected area.