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PubMed1998

The nature of the spondylolytic defect. Demonstration of a communicating synovial pseudarthrosis in the pars interarticularis.

We injected methylene blue dye into 32 of the facet joints immediately above the defects in 17 consecutive patients with bilateral spondylolysis (34 defects). In 30 of these the dye flowed into a central cavity in the defect of the pars interarticularis and in 20 it passed into the facet joint below the defect. We found macroscopic cavities in 32 of the defects which communicated with the adjacent facet joints and had fibrous capsules. Histological examination showed focal areas of synovial lining consistent with a synovial pseudarthrosis. In most patients requiring surgery for spondylolysis, the defect is a synovial pseudarthrosis which communicates with the facet joint above it, and less often with the facet joint below it. We suggest that stress fractures of the pars may fail to heal because of the presence of synovial fluid from a nearby facet joint.

Adult↗
PubMed1996

Repair of a pseudarthrosis of the lumbar spine. A functional outcome study.

Eighty-six patients had a total of eighty-eight primary attempts at repair of a pseudarthrosis that had developed after a localized arthrodesis in the lumbar spine. A follow-up questionnaire was sent to all patients at a mean of fifty-one months (range, twenty-five to seventy-eight months) after the operation; seventy-two patients (84 percent) completed to questionnaire. A solid fusion was ultimately achieved after the treatment of eighty-one (94 percent) of the eighty-six pseudarthroses for which radiographic data were available. With the numbers available, we could find no significant association between a solid fusion and the patient's age, gender, body-mass index, return to work, or outcome score. Despite the high rate of fusion after the index repair and subsequent procedures, only nineteen (26 percent) of the seventy-two patients who completed the questionnaire eventually had a good or excellent outcome. Seven (10 percent) had an excellent result (90 to 100 points), twelve (17 percent) had a good result (70 to 89 points), fourteen (19 percent) had a fair result (50 to 69 points), and thirty-nine (54 percent) had a poor result (less than 50 points). Nevertheless, fifty-one patients (71 percent) reported that the operation led to some improvement, and fifty-five (76 percent) said that they would have the operation again if the circumstances were similar to those before the repair of the pseudarthrosis. Thirty-four of the seventy-two patients were smokers and thirty-eight were non-smokers at the time of the operation. There was a negative linear association between the outcome scores and the number of pack-years (p = 0.02). Cessation of smoking before the operation positively affected the outcome; the patients who had stopped smoking had a mean outcome score of 65 points, compared with 45 points for those who had not stopped (p = 0.03). Patients who had stopped smoking were also more likely to return to work full time (p < 0.001). At the latest follow-up evaluation, twenty of the seventy-two patients had returned to full-time employment. Patients who had been receiving Workers' Compensation at the time of the operation generally did poorly on the outcome questionnaire, but, with the numbers available, they did not have a significantly different rate of solid fusion than patients who had not been receiving Workers' Compensation. Also, the outcome score and the rate of fusion were nor significantly affected by age or by obesity.

Adult↗
PubMed1978

Congenital pseudarthrosis of the radius.

Five children with six congenital pseudarthroses of the long bones of the forearm are described. Four cases were the result of neurofibromatosis, one was related to fibrous dysplasia, and one appears to be idiopathic. Whereas congenital pseudarthrosis of the leg primarily involves the tibia, congenital pseudarthrosis of the forearm primarily involves the radius. Four of the children were treated with bone grafts of the radius, three requiring repeated grafting. The etiology, differential diagnosis, long term prognosis, and treatment correlate with the data of similar lesions in the tibia. Thus the reason for poor fusion is probably unrelated to weight bearing but is rather the result of underlying bone pathology.

Child, Preschool↗
PubMed1977

Early and late results of Brackett's operation for pseudarthrosis of the neck of the femur in infantile coxa vara. A review of 30 operations.

The early and late results of 30 Brackett operations for pseudarthrosis of the neck of the femur are reviewed. The cause of the pseudarthrosis in 28 hips was congenital or infantile coxa vara. The patients' ages at the time of the operation ranged from 2 to 43 years. The early results were good. Only three out of a total of 30 cases failed to unite; 27 hips became stable. Necrosis of the femoral head occurred in six hips. Late results, on average 13 years after the operation, differed greatly from the early results. The majority of the hips were stable but only three completely painless. All but four were affected by secondary osteoarthritis which in six cases was slight.

Adolescent↗
PubMed1986

Vascularized fibular grafting for the treatment of congenital pseudarthrosis of the tibia.

Six patients with congenital pseudarthrosis of the tibia were treated with vascularized fibula transplantation after the abnormal pseudarthrosis site had been radically debrided. At the time of surgery, the patients' ages ranged from 18 months to 5.5 years, and follow up was from 9 months to 4.5 years. All the fibular transplants healed and the patients were all fully weight bearing in a brace 6-months postoperatively. Age at fracture or surgery, site of the fracture, or radiographic appearance were not contraindications to the use of this technique. Although three of the patients required one further operation, the short- and long-term problems have been relatively minor. This technique has proven successful in managing many resistant patients with this difficult orthopedic problem.

Child, Preschool↗
PubMed1999

Left-sided congenital pseudarthrosis of the clavicula.

This a well-documented case of a 13-year-old girl with unilateral pseudarthrosis of the left clavicle without the presence of cervical ribs or dextrocardia. Magnetic resonance imaging could not detect any abnormality that could be related to the left-sided pseudarthrosis.

Adolescent↗
PubMed1975

Direct-current stimulation of non-union and congenital pseudarthrosis. Exploration of its clinical application.

Based on the response of bone to electrical current in previous studies, an exploratory clinical study of the effect of electrical current on non-union and congenital pseudarthrosis was performed. Constant direct current of ten to twenty microamperes was applied to twenty-four non-unions and five congenital pseudarthroses. Complete union occurred in fifteen non-unions and in one congenital pseudarthrosis. A single cathode delivering ten microamperes seemed sufficient to heal non-union in small bones, but multiple cathodes each delivering twenty microamperes appeared to be required to heal non-union in the tibia and femur. As the technique was refined, the percentage of successes increased. While these preliminary results appear promising, further laboratory and clinical experiments are required to define the true role of electrical stimulation in clinical practice.

Adolescent↗
PubMed2000

Thoracolumbar pseudarthrosis.

Pseudarthrosis is the leading cause of failed spine fusion and is of paramount concern to surgeons attempting fusion procedures. Thus, it is essential to understand this complication to direct efficient and intelligent management. A review of various modalities in the identification and diagnosis of a pseudarthrosis is presented. In addition, its histologic features and classification system are discussed. Not all pseudarthroses need treatment. When treatment is considered, however, there are both nonoperative and operative strategies. Operative alternatives include posterolateral, anterior, or anterior-posterior combined fusions.

Humans↗
PubMed2001

Fibula pseudarthrosis revisited treatment with Ilizarov apparatus: case report and review of the literature.

A case of isolated congenital fibula pseudarthrosis with progressive valgus ankle deformity is reported. Valgus deformity can be corrected early by Ilizarov apparatus. Bone grafting is an essential part of treatment for union of the pseudarthrosis site. Internal splinting may be helpful in preventing further valgus deformity by maintaining continuity of fibula. Age of presentation has an important bearing on the choice of treatment.

Ankle Joint↗
PubMedDate not supplied

Congenital pseudarthrosis of the clavicle: a proposal for early surgical treatment.

We present a review of six cases of children with congenital pseudarthrosis of the clavicle, treated and followed up at the "La Fe" Hospital for Children. One of them had bilateral involvement. Five of them, including the bilateral case, were surgically treated at ages ranging from 18 months to 4 years. Bone graft and internal fixation with a Kirschner wire were used. Healing of the pseudarthrosis was obtained in all patients in 6-8 weeks. We discuss the suitability of early surgical treatment that, in our opinion, produces very satisfactory results.

Bone Wires↗
PubMedDate not supplied

Parafocal osteotomy and the Ilizarov method in the treatment of femoral pseudarthrosis. Case report.

The case presented is that of a man aged 54 years, with hypertrophic pseudarthrosis shortening by 3 cm and a femoral mechanical axis measuring 13 degrees varus. Parafocal osteotomy according to Paltrinieri was carried out with the aim of correcting the varus femur, the shortening and, secondarily, of obtaining recovery from the pseudarthrosis. Osteosynthesis was achieved by the Ilizarov apparatus. Axial correction and lengthening were obtained after 33 days. The fixator was removed after 5 months and 10 days, during which the nonunion appeared healed.

Femoral Fractures↗
PubMed2002

[Histopathology of congenital pseudarthrosis of tibia].

OBJECTIVE: To investigate the histopathology, origin, and etiology of congenital pseudarthrosis (CPT). METHODS: Specimens of periosteum from 28 CPT cases, 20 cases of traumatic pseudarthrosis (TP), 10 cases of fibromatosis, and 10 normal controls were examined. The pathological changes were observed by electron microscopy and confocal microscopy. The expression of alpha-smooth muscle (SM) actin, vimentin, desmin, bone morphogenic protein (BMP), interleukin (IL)-1, IL-6, tumor necrosis factor-alpha (TNF-alpha) and base fibroblast growth factor (b-FGF) were detected by histochemistry and immunofluorescence chemical staining. Chromosomal karyotype was examined among 11 cases of CPT. RESULTS: (1) Electron microscopy showed that the periosteum and soft tissue between the broken ends in CPT were all dense fibrous connective tissue abundant in cells, including fibroblasts, myofibroblasts, etc. (2) The chief collagen element was type I collagen in normal periosteum and was type III collagen in periosteum of patients with CPT and fibromatosis (P < 0.025). (3) Vimentin was positive and desmin was negative in all specimens. The expression of alpha-SM actin was higher in specimens from CPT and fibromatosis than in specimens from normal control and TP (P < 0.01). The expression of BMP was higher in normal periosteum and TP than in the periosteum of CPT and fibromatosis (P < 0.05). The expression of IL-1, IL-6, TNF-alpha, b-FGF was higher in the periosteum of CPT and TP (P < 0.01). (4) The chromosomal karyotype of all CPT patients was normal 46XY or 46XX. CONCLUSION: (1) Neurofibromatosis is probably not the etiological factor of CPT. (2) CPT is a kind of invasive fibromatosis located in periosteum. (3) Abnormal expression of many kinds of cytokine and high expression of type III collagen play an important role in the pathogenesis of CPT. (4) The main pathology of CPT is hyperplasia of fibroblasts, thus causing thickening of periosteum, contractible circinate coarctation, and compression of tibia and surrounding tissues. (5) The chromosomal karyotype of patients with CPT is normal.

Adolescent↗
PubMed2003

Tibiocalcaneal Marchetti-Vicenzi nailing in revision arthrodesis for posttraumatic pseudarthrosis of the ankle.

The authors conducted a retrospective study of 7 patients treated with tibiotalocalcaneal Marchetti-Vicenzi nailing (one anterograde and six retrograde nails). All these patients had developed pseudarthrosis after previous arthrodesis for posttraumatic ankle fractures. The results were evaluated clinically and radiographically at a median time of four years. Fusion occurred in three patients, in one of them only after removal of the proximal locking screw. Of the remaining four patients, one achieved consolidation after replacement of the Marchetti-Vicenzi nail by another intramedullary nail, two were lost to follow-up after replacement by external or internal fixation, and the last patient developed pseudarthrosis again. At least nine additional interventions were necessary in six patients, including one amputation for intractable pain and severe soft-tissue damage due to the trauma. None of the patients had excellent or good results. The majority was unsatisfied with this type of intramedullary nailing. Therefore our study was terminated prematurely. Revision ankle fusion for nonunion or malunion after external or internal fixation has a high complication rate. Further study is mandatory to prevent or resolve remaining problems.

Adolescent↗
PubMed2003

Efficacy of percutaneous vertebroplasty in the treatment of intravertebral pseudarthrosis associated with noninfected avascular necrosis of the vertebral body.

STUDY DESIGN: A retrospective clinical study on the effect of percutaneous vertebroplasty (PVP) in the treatment of intravertebral pseudarthrosis caused by avascular necrosis of a vertebral body. OBJECTIVES: To evaluate the efficacy of PVP in the treatment of spinal instability associated with avascular necrosis. SUMMARY OF BACKGROUND DATA: Two radiologic features of avascular necrosis of a vertebral body are intravertebral vacuum phenomenon and fluid collection, combined with a collapsed vertebra. These can sometimes result in dynamic instability due to intravertebral pseudarthrosis. A treatment for this instability, associated with avascular necrosis, has not been established. METHOD: Sixteen patients with instability, associated with avascular necrosis of a vertebral body, were treated by PVP. The indicators of the condition included spinal instability associated with avascular necrosis, which was diagnosed by a vacuum phenomenon or by fluid collection in the vertebral body as found from imaging studies. The instability of the vertebral body was confirmed from the dynamic lateral view in both flexion and extension. The anterior body height and kyphotic angle changes between pre- and post-treatment were measured on a lateral radiograph. Plain radiography was used during the follow-up period (8-14 months; mean, 11 months) to assess the vertebral column stability. The pain level of each patient was assessed, both before and after the procedure, using a visual analog scale (VAS), ranging from 0 to 10. Marked or complete pain relief was achieved in eight (50%) patients, and moderate pain relief in six (38%), with the immediate postoperative average pain score reduced from 9.0 to 4.3. The mean corrected angle and vertebral height between pre- and post-treatment were 8.5 degrees and 7.0 mm (P =0.001), respectively. There was no significant change in the kyphotic angle of the treated level during the follow-up period (P =0.711). CONCLUSIONS: Percutaneous vertebroplasty is a reasonable procedure for the treatment of spinal instability associated with avascular necrosis, but not that caused by an infection. PVP was found to be a minimally invasive and effective procedure that provides pain relief and stabilization of spinal instability associated with noninfected avascular necrosis of the vertebral body.

Aged↗
PubMed1992

[Surgery for pseudarthrosis of the scaphoid bone performed in Hungary 1988].

Authors analyse, based on an all-round inquiry, the operations performed for pseudarthrosis of the scaphoid in 1988. It was found that 344 of 472 operations were reconstructive, 128 palliative. The single types of operation are briefly described. They hint at the fact that the operative treatment of scaphoid pseudarthrosis in Hungary is carried out mostly in Centers.

Carpal Bones↗
PubMed2004

Fracture of the clavicle after surgical treatment for congenital pseudarthrosis.

BACKGROUND: Congenital pseudarthrosis of the clavicle is a rare disease. There are about 200 individual cases reported so far in world literature, mainly in the form of case reports. The majority of authors recommend surgical. An analysis of 103 cases published since 1980 shows only a few post-surgical complications. CASE REPORT: The authors present a female patient operated at the age of 4.5 years. During surgery both cartilaginous ends were resected and internal fixation was performed by a one-third semitubular plate fixed by 3.5 mm cortical screws. Ten days after hardware removal, a fracture occurred in the screw-hole following a minor impact. Surgery to heal the congenital pseudarthrosis was successful, but a new fracture occurred, resulting from bone weakening. This simple fracture was treated conservatively. At present (5 years after the first surgery) the patient's parents are completely satisfied with both the functional result and the cosmetic appearance. CONCLUSIONS: The authors have not found in the literature any reports of similar complications after surgical treatment of this condition. The use of more delicate osteosynthetic material might prevent the complication described here.

Child, Preschool↗
PubMed2004

Pseudarthrosis after lumbar spine fusion: nonoperative salvage with pulsed electromagnetic fields.

We studied 100 patients in whom symptomatic pseudarthrosis had been established at more than 9 months after lumbar spine fusion. All patients were treated with a pulsed electromagnetic field device worn consistently 2 hours a day for at least 90 days. Solid fusion was achieved in 67% of patients. Effectiveness was not statistically significantly different for patients with risk factors such as smoking, use of allograft, absence of fixation, or multilevel fusions. Treatment was equally effective for posterolateral fusions (66%) as with interbody fusions (69%). For patients with symptomatic pseudarthrosis after lumbar spine fusion, pulsed electromagnetic field stimulation is an effective nonoperative salvage approach to achieving fusion.

Adult↗