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PubMed2005

[A case of congenital pseudarthrosis of the clavicle].

Congenital pseudarthrosis of the clavicle is a rare condition of unknown etiology. It usually presents as a painless mass in the clavicular region; however, it may sometimes be associated with pain and weakness in the shoulder. We presented a 21-year-old male patient who had pain and weakness in the right shoulder during sportive and daily vigorous activities due to congenital pseudarthrosis of the clavicle. The patient was successfully treated by excision of the ends of the medial and lateral fragments, reconstruction of the defect with a tricortical iliac crest autograft, and internal fixation of the clavicle with a plate and bone screws. After seven months postoperatively, his complaints disappeared, with a full range of motion and Constant score.

Adult↗

PubMed1991

Congenital pseudarthrosis of the forearm and fibula. A case report.

Congenital pseudoarthrosis of the ulna and contralateral fibula occurred in a seven-year-old boy. Multiple limb involvement is extremely rare and has only been reported involving the tibia and fibula. Congenital pseudarthrosis of the tibia is a well-known entity, with other bones affected much more rarely. A case is reported involving the ulna and the contralateral fibula. This appears to be the first case of congenital pseudarthrosis reported involving an upper and a lower limb.

Child↗

PubMed1990

Late paraparesis due to pseudarthrosis after posterior spinal fusion.

The authors report three cases in which paraparesis related to a pseudarthrosis occurred several years after a posterior spinal fusion, but with a different mechanism (stretching of the spinal cord for progression of the deformity in kyphosis in two cases, and spinal cord compression for bone overgrowth within the canal in the site of pseudarthrosis in the third patient). Treatment was different. Partial correction of the deformity and stabilization of the spine by combined fusion (anterior and posterior) was sufficient in the first two cases for a complete neurological recovery. Posterior spinal cord decompression and stabilization of the spine by combined fusion was necessary for complete recovery in the third.

Adult↗

PubMed1990

Surgical treatment of tibial pseudarthrosis using the Ilizarov apparatus. A critical analysis.

Since November 1985 the authors have added the Ilizarov procedure to their armamentarium for the treatment of tibial pseudarthrosis. The results of a first clinical study of 10 patients are reported. The mean duration of follow-up is 17 months. The consolidation rate is higher with a transverse than with an oblique pseudarthrosis. The Ilizarov procedure combined with a corticotomy offers new perspectives in the management of massive bone defects. In the presence of severe malalignment, a gradual reduction can be carried out. The main complications are pin tract infections and algodystrophy.

External Fixators↗

PubMed1990

Pseudarthrosis of the cervical spine after anterior arthrodesis. Treatment by posterior nerve-root decompression, stabilization, and arthrodesis.

Nineteen consecutive patients who had a symptomatic pseudarthrosis after a failed anterior cervical arthrodesis were treated by a posterior nerve-root decompression and arthrodesis. The indications for the operation were radiculopathy in the absence of myelopathy and evidence of a pseudarthrosis on lateral flexion and extension radiographs. The average duration of follow-up was forty-four months (range, twenty-four to fifty-four months). A solid fusion was achieved in all patients, and the radiculopathy was relieved in all but one. The motor weakness that had been present in four patients preoperatively resolved completely.

Adult↗

PubMed1989

Congenital pseudarthrosis of the tibia. Long-term follow-up study.

Review of the literature reveals how difficult it is to assess the results of treatment of pseudarthrosis of the tibia. There is disagreement as to when the result can be considered final. This study reviewed the long-term results of treatment to determine if skeletal maturity could be considered the definitive end point of treatment or if the results deteriorate past skeletal maturity. In addition, the effect of neurofibromatosis on pseudarthrosis of the tibia is analyzed. Forty-one patients were reviewed. Only 25 had sufficient follow-up data to be included in this study. Eighteen of the 25 had neurofibromatosis. The results were classified according to criteria developed by Morrissy et al. At skeletal maturity, there were ten good results, three fair results, and three poor results, with nine patients having had amputation. At long-term follow-up evaluation (average 36 years; range five to 62 years), one patient with a fair result had elected amputation. About one half of the patients with neurofibromatosis required amputation. This study suggests that the results at skeletal maturity are reliable indicators of long-term results.

Adolescent↗

PubMed1989

[Surgical treatment of aseptic forearm shaft pseudarthrosis].

Non union of a lower arm fracture (without infection) is the result of inadequate immobilization or of too extensive devastation of the bone. Within 1975 to 1985 in the accident-hospital of Tübingen we saw 131 pseudarthroses of the ulnar or radius shaft in 111 patients. Among these a hypertrophic pseudarthrosis is mostly seen after conservative treatment or operative treatment with intramedullary nailing. Atrophic pseudarthroses or defect pseudarthroses mostly occur after open fractures, comminuted fractures or insufficient plate osteosynthesis. The operative treatment was regularly a plating of radius and/or ulna (mostly with the 3.5 mm AO-DC-plate) combined with correction of axis or rotation deformity. Depending on the type of the pseudarthrosis, decortication was also performed as well as an autogenous bone-grafting or an interposition of a cortical-cancellous-block. All but one of the pseudarthroses each of the ulna and radius, healed completely. Most patients had a reduction of pain, improvement of mobility of the elbow or wrist joint, especially an improvement of supination/pronation, regarded as an index of correction of a malrotation. Postoperative physiotherapy has to be most careful; the best physiotherapy is the everyday active use of the arm by the patient himself.

Adult↗

PubMed1989

Congenital pseudarthrosis of the tibia. An overview.

Congenital pseudarthrosis of the tibia was perhaps described almost 300 years ago, yet it remains one of the most difficult conditions to treat in orthopedic surgery. Recent advances in surgical techniques have given much more encouraging results. Coleman has played a significant role in this progress with his concept of complete correction of the tibial and fibular deformities and fixation with strong and long intramedullary rods. To this technique have been added autologous cancellous bone grafting and electrical stimulation. These advances have increased the rate of successful union of the pseudarthrosis of the tibia. More recently, transfer of a vascularized fibular graft with correction at the same time of the leg-length discrepancy has offered even greater hope for achieving successful bony union of the tibia. This treatment involves surgery on the normal leg. Long-term results of this method of management are eagerly awaited.

Humans↗

PubMed1989

Congenital pseudarthrosis of the tibia: treatment with local steroid infiltration.

A new treatment was used for 3 cases of congenital pseudarthrosis of the tibia based on the method used for the treatment of simple bone cysts by local infiltration of steroids. All 3 cases achieved consolidation and had no recurrence. This method may be used in association with the numerous other methods used in the treatment of congenital pseudarthrosis of the tibia (bone transplants, vascularized transplants using microsurgical techniques, electromagnetic induction, and the use of external fixators). It is particularly useful for cases treated at a very early age (even at a few months) when other types of treatment could be difficult to carry out and usually fail.

Child, Preschool↗

PubMed1989

Wedge osteotomy of the lower end of the radius in the treatment of painful pseudarthrosis of the carpal scaphoid bone.

The present authors have had encouraging results in the treatment of painful pseudarthrosis of the carpal scaphoid bone using wedge osteotomy on the lower end of the radius. After the operation, patients experienced restoration of joint movement, less painful or pain-free joints, and, in a few cases, sound union of the established pseudarthrosis of the carpal scaphoid bone. Osteotomy is a simple procedure of short duration and is without complications. In addition, in cases of failure, osteotomy does not exclude other forms of therapy.

Adult↗

PubMed1988

Thoracic outlet syndrome with congenital pseudarthrosis of the clavicle: treatment by brachial plexus decompression, plate fixation and bone grafting.

Although a number of cases of congenital pseudarthrosis of the clavicle have been described in the literature, they provide little direction for the treatment of this condition when it is associated with thoracic outlet syndrome. The authors describe their experience with such a case in a 20-year-old woman. Symptoms of pain in the ulnar distribution of the right forearm and discoloration of the hand with abduction of the extremity had developed over 3 years. The radial pulse was obliterated by abduction of the arm. Exploration of the brachial plexus revealed a constricting band arising from the distal fragment of the clavicle running to the first rib which, together with the mass of the pseudarthrosis, comprised the thoracic outlet. The patient was successfully treated by division of the fibrous band, reduction of the clavicle, internal fixation with a plate and iliac crest bone grafting. At follow-up the patient had a full range of motion in the shoulder and was asymptomatic.

Adult↗

PubMed1987

[Congenital pseudarthrosis of the tibia and fibula in children. Results of the treatment of 18 cases with nails and bone grafts].

Eighteen cases of congenital pseudarthrosis of the leg in 17 children were treated by nailing and tibio-fibular graft with a mean follow-up of six years (from one to twelve years). Six patients had reached the end of growth. Primary union was obtained in 17 cases in a mean time of 6.5 months (from 3.5 to 18 months), but one case developed a new pseudarthrosis at the level of an associated upper tibial osteotomy. Only one case required a supplementary graft. Walking was usually achieved without any apparatus after five-and-a-half months, the tibia being protected by a nail which was left in place until the end of growth. In two cases, a fracture produced by trauma occurred in the limb long after consolidation. These two fractures healed in the normal time. Inequality of limb length was present in all the cases, but its progress varied. On three occasions it was treated by femoral lengthening. Stiffness of the ankle and subtaloid joints resulted from nailing of the hindfoot in nine cases and improved very little after freeing of the joints. The use of telescopic rods avoids the need for further operations to change the rod during growth. We consider that this is a reliable method but that, in certain cases, the effects on growth and on the foot can be diminished by appropriate modifications of technique.

Bone Transplantation↗

PubMed1986

[Osteomyelitic pseudarthrosis of the tibia with loss of substance treated with a graft of the opposite fibula].

Dragan Dj./Re. No. 2755/76, 5,5-year-old boy, referred to this hospital with signs of bipolar osteomyelitis, destruction and fistulisation of the left tibia and talocrural arthritis. Staphylococcus albus and streptococcus haemoliticus were isolated from the fistula. Osteomyelitis was treated with an adequate therapy including long usage of Lincocin. In Feb. and Oct. of 1977 a sequestrotomy of the mid portion of the tibia and transmedular fixation using Ratschmann's nail were performed. The process resulted in pseudarthrosis of the mid portion of the tibia with loss of bone substance in the length of 2.5 cm and talocrural arthrosis and deformed foot. The boy walking support. In July 1980, in the stage of "ripe" pseudarthrosis a complete resection of pseudoarthrosis with sclerotic portions of tibia to healthy bone was performed. The mid part of the right tibia was resected subperiostally and was grafted centromedularlly into the upper and lower medular channel of the left tibia. Two Kirschner's needles were implanted centromedularlly so as to strengthen the bone osteosynthesis. Complete union of the grafted fibula with treppassage of the medular channel occurred with its tibilisation and growth in length and width. In July 1982, the concave foot was corrected using Bertrand's method. The present difference in the length between the two legs is 4.5 cm which is corrected by the use of padded shoes. Lengthening of the leg is planned to be performed before he reaches the age of 14.

Child↗

PubMed1979

[Results of screw fixation of the scaphoid pseudarthrosis].

MATTI-RUSSE's cancellous graft is successful in the management of scaphoid pseudarthrosis. The necessity of post-operative immobilization of the wrist, usually previously immobilized, for up to 16 weeks is its disadvantage. Screw fixation including radial styloidectomy and a small cancellous graft is an alternative abbreviating immobilization to only 2 to 6 weeks. the follow-up of 26 patients thus operated revealed osseous union in 19 cases. The failures were due to lack of proper indication or faulty technique. In spite of the correct position of the scaphoid screw one pseudarthrosis did not heal, the clinical result being satisfactory. The procedure described permits early remobilization of the wrist. Failures, also described by other authors, can be avoided by proper indication and technique.

Adult↗

PubMed1985

A comparison of different methods used to diagnose pseudarthrosis following posterior spinal fusion for scoliosis.

Pseudarthrosis is a recognized complication of posterior spinal fusion for scoliosis, and its early recognition and repair may prevent loss of correction, failure of the instrumentation, or pain. In this study of 200 fusions for scoliosis, we compared the reliability of different methods that are currently used to determine the presence or absence of a pseudarthrosis. Anteroposterior tomography was found to have the highest rate of correlation (96 per cent), as there was only one false-negative study. Other methods of diagnosis--including anteroposterior, lateral, and oblique radiographs and clinical findings such as loss of correction and back pain--were less accurate.

Adolescent↗

PubMed1985

The role of osteotomy in the treatment of pseudarthrosis of the neck of the femur in younger patients.

The authors discuss 34 cases of pseudarthrosis of the neck of the femur that were subjected to two different types of osteotomy, namely the support osteotomy of Putti and the valgising osteotomy of Pauwels. The following conclusions were reached: both methods produced good healing of the pseudarthrosis; with regard to the functional result, valgising osteotomy associated with a degree of lateralisation must be the operation of choice because it compensates for the shortening and prevents the Trendelenburg gait.

Adolescent↗

PubMedDate not supplied

Congenital pseudarthrosis of the clavicle.

This is a report of 5 cases of congenital pseudarthrosis of the clavicle, a rare disorder of the shoulder girdle. Little more than 100 cases have been reported in the literature; 3 of our 5 cases represent a very rare form of left side involvement with dextrocardia. The pseudarthrosis mass generally protrudes under the skin and may need surgical correction. When unilateral, there is marked and unexplained predominance for the right side. Three cases required no treatment; 2 were successfully treated by excision of the bone ends, bone grafting and internal fixation.

Child↗

PubMed1983

[Treatment of irreparable scaphoid bone pseudarthrosis and necrosis by partial resection of the scaphoid].

After review of the literature on scaphoid pseudarthrosis and resection, the authors give an evaluation of twenty-five palliative operations for non-reconstructible scaphoid pseudarthrosis, (some in combination with resection of the styloid process). The results were generally good. Failures are found only in cases of insufficient proximal scaphoid resection or of preoperative wrist arthrosis which was too advanced. Partial resection of the scaphoid seems in most cases preferable to the alternative trans-scapho-lunar resection (resection of the lunate and the proximal half of the scaphoid as recommended by Steinhäuser). This bigger intervention seems justified only in cases of advanced arthrosis of the proximal wrist. In cases of severe generalised wrist arthrosis, however, arthrodesis is recommended.

Adult↗