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PubMed1983

[Results of surgically treated scaphoid pseudarthrosis using the Matti-Russe method].

For the treatment of scaphoid pseudarthrosis which is recognized sufficiently soon after an accident and where are no arthritic changes, the best method is that described by Matti-Russe; in our series we found healing in 95%. By grafting an autologous cortico-cancellous bone from the ilium we had no failures when we diagnosed and operated on the pseudarthrosis in the first five years after injury. We, therefore, now operate also on fractures with delayed union. The resection of the radial styloid process in combination with the Matti-Russe method has shown no advantages, and we have abandoned this modification.

Adolescent↗

PubMed1984

Treatment of congenital and infantile pseudarthrosis of the tibia with pulsing electromagnetic fields.

The management of congenital and infantile pseudarthrosis of the tibia poses difficult problems because of the variability in the type and prognosis of the lesion and varied response to surgical treatment. Whatever the severity of the lesion, the use of pulsed electromagnetic fields can be expected to improve the prognosis for union by a factor of at least 20 per cent. In a very few patients, usually those with pseudarthrosis presenting later in life, pulsed electromagnetic fields alone together with plaster immobilization may be sufficient to produce union. In some, partially successful previous surgery may be made completely successful by subsequent application of pulsed electromagnetic fields. In patients with a fair or good prognosis as regards the type of lesion, a combination of surgery and pulsed electromagnetic treatment, some period of which may also be given before surgical treatment, gives a moderately high rate of success. In the three groups already described, the overall success rate is likely to be more than 70 per cent. In lesions with a poor prognosis, or after multiple surgical procedures in an older child, a combination of very adequate further surgery and pulsed electromagnetic fields can produce union in perhaps 30 per cent of cases, but it is unwise to commence any treatment if the limb is already unacceptably short, if there is gross wasting of the limb with evidence of inadequate vascular supply, and/or if the joints of the foot and ankle are stiff and associated with deformity. In such cases, the procedure of choice is amputation.

Adolescent↗

PubMed1984

The transtibio-fibular graft in the treatment of pseudarthrosis of the tibia with loss of bone substance.

The transtibio-fibular graft is the treatment of choice in pseudarthrosis of the tibia with significant loss of bone, particularly in the presence of infection or potential infection. A personal series of 28 cases is reported. The method consists of stabilizing the pseudarthrosis, usually after radical surgical cleansing, by applying the grafts through healthy tissues from a postero-lateral approach. The authors stress that this operation is only called for when the amount of bone loss is substantial. In the less severe cases the operation restores sufficiently strong union to prevent future fatigue fractures, whilst even in cases of more extensive bone loss it still offers an excellent prospect of avoiding such possible future complications.

Adolescent↗

PubMed1980

Congenital pseudarthrosis of the tibia: treatment with vascularized autogenous fibular grafts. A preliminary report.

A review of the literature concerning the classification, etiology, histology and treatment of congenital pseudarthrosis of the tibia is presented. The authors describe two patients in whom resection of the lesion and reconstruction of the extermity with free vascularized fibular grafts were performed. Preliminary results after a short period of follow-up indicate that the technique may be an appropriate method for treatment of congenital pseudarthrosis of the tibia, since "the living graft" is not dependent upon the recipient bed for survival. Progressive hypertrophy of the graft without resorption is demonstrated.

Child, Preschool↗

PubMed1980

Treatment of congenital pseudarthrosis of the tibia with direct current stimulation.

Congenital pseudarthrosis of the tibia presents surgeons with one of the most challenging of all orthopedic problems. The results of various forms of surgical treatment are rarely successful. This is a preliminary report on an implanted direct current bone growth stimulator (DCBGS) for treatment of congential pseudarthrosis of the tibia. The implanted stimulator achieved encouraging results in 6 patients when it was used in conjunction with cancellous bone grafting and efficient immobilization of the tibia. The leg requires long-term protection of the fracture site until skeletal maturity is complete.

Child↗

PubMed1982

Fractures and pseudarthrosis of the carpal scaphoid.

The ultimate outcome of fractures of the scaphoid bone is determined by the choice of initial treatment. The special characteristics of the blood supply to the bone, which often increase the risk of non-union, have prompted us to propose the indications for primary surgical treatment based on the radiographic appearances. The authors propose a classification of the radiographic characteristics of fractures of the scaphoid for determining at the outset the treatment most likely to achieve consolidation and hence a more rapid resumption of occupational and sports activities. They present the results obtained in the treatment of 101 recent fractures of the scaphoid, eighty-one of which they were able to follow up after at least one year. In cases of established pseudarthrosis of the scaphoid they propose a pedicled transplant technique as conforming better to the anatomical, morphological and functional pre-requisites of the operation. The results obtained in the treatment of twenty-nine cases of pseudarthrosis are presented. The case material relates to patients treated at the G. Pini Orthopaedic Institute of Milan and, in the case of sportsmen, at the Centre for sports injuries of the same institute.

Carpal Bones↗

PubMed1981

[Tibial infectious pseudarthrosis. Treatment and results. Clinical study of 25 cases].

Our follow-up results demonstrate that in the majority of cases the infected pseudarthrosis is the result of a primary, relatively unfavourable initial condition. Second and third grade, open comminuted fractures of the tibia are particularly endangered. Despite correct treatment the amputation rate came up to 10%. With a strict, long-term treatment plan which emphasizes sufficient stabilisation of the infected pseudarthrosis, however, it is possible to achieve relatively good results in about two thirds of all cases. This has been confirmed by the clinical as well as the functional results obtained.

Adult↗

PubMed1980

Congenital pseudarthrosis of the clavicle.

A case of congenital pseudarthrosis of the clavicle is presented. Congenital pseudarthrosis of the clavicle is an entity that has rarely been recorded in the radiological literature. The etiology of the condition remains obscure. The radiographic appearance is characteristic.

Adult↗

PubMed1980

[Congenital pseudarthrosis of the clavicle. Apropos of 7 cases].

The authors report 7 new cases of congenital pseudarthrosis of the clavicule. Clinical features are bearing out classical data of litterature. The disease is discovered during first months by the way of a clavicular swelling which settles mostly on the right side. But according to the authors the surgical treatment ought to be systematically purposed, restoring a normal morphology and avoiding any functional trouble. It consists in resecting the pseudarthrosis and grafting. This act is easy if done early, the ideal age being around 3 or 5.

Adolescent↗

PubMedDate not supplied

The Ilizarov method for the treatment of infected pseudarthrosis of the tibia: our experience in cases with severe lesion of the soft tissues.

Between 1985 and 1990 a total of 35 cases of infected pseudarthrosis of the tibia were treated by radical resection of the pseudarthrosis and corticotomy-distraction-compression. In 5 patients there was severe lesion of the soft tissues with extensive loss of substance. It is the purpose of the present study to evaluate the effects of the use of this method on lesions of the soft tissues in these 5 patients.

Adolescent↗

PubMed1993

[Ipsilateral inverse fibula transposition for treatment of congenital tibial pseudarthrosis].

Congenital pseudarthrosis of the tibia is one of the most challenging problems in reconstructive surgery. A wide variety of surgical methods has been utilised to treat this condition: One is the free transposition of the vascularised fibular segment to bridge the gap of pseudarthrosis. The authors report their experience in using a vascularised pedicled fibular segment of the ipsilateral fibula with reverse peroneal flow. Three patients were treated successfully. Progressive hypertrophy of the grafts without resorption was demonstrated. Within one year, all children were able to walk without an orthesis.

Angiography↗

PubMed1996

[Contribution of Ilizarov's equipment in the treatment of congenital pseudarthrosis of the lower limb].

INTRODUCTION: Risks and benefits of using Ilizarov apparatus in the treatment of congenital tibial or fibular pseudarthrosis (CTFP) are presented in this retrospective study. MATERIALS AND METHODS: We reviewed with an average follow-up of 3 years and 4 months, the outcome of twenty consecutive patients treated between 1985 and 1993, for a CTFP using the Ilizarov apparatus. Sixteen patients were treated for non union of both tibia and fibula, 1 patient for an isolated non union of the fibula, and 3 patients for correction of a previously treated, malunited pseudarthrosis. The apparatus was used in four different ways: Realignement, end to end compression, and leg lengthening in 14 cases, Simple external fixation in association with another method of treatment in 2 cases, Progressive correction of malunion in 3 cases, Progressive diaphyseal reconstruction in 1 case (fibula). RESULTS: The mean fixation duration was 7.3 months. Union was achieved with the initial treatment in 11 out of 20 cases (including the 3 cases of malunion correction). Bone grafting was used in 7 out of the 9 remaining cases, and led to bone healing in 3 of them. Five complications were encountered: deep infection in 1 case, repeated stress fracture in 1 case, repeated fracture of the pins in 1 case, malunion in 6 cases, and less than 3 cm leg length discrepancy in 4 cases. DISCUSSION: Ilizarov external fixator is an efficient solution for many cases of CTFP, in which healing did not occur with other methods of treatment. The best indication for its use are the normotrophic and the hypertrophic types of non union (Apoil II), after the age of 4 or 5. Secondary massive bone grafting is to be considered in some cases, since it can either achieve bone union or strengthen it. The major disadvantage of this method is the lack of excision of the dystrophic tissue at the non union site. So, even after the non union is healed, the bone remains dystrophic and fragile, and necessitates a permanente protective orthosis, until the end of bone growth.

Adolescent↗

PubMed1996

[Spontaneous vertebral pseudarthrosis in ankylosing spondylitis. Apropos of 3 cases].

PURPOSE OF THE STUDY: The authors describe the surgical treatment of three cases of vertebral pseudarthrosis in two patients suffering from rheumatoid spondylitis for an average of 20 years. MATERIAL: Two pseudarthrosis involved the thoracic level (T9-T10 and T10-T11), after an insignificant trauma. In the other case, the lesion was a secondary localization (L5-S1) arising spontaneously two years after the treatment of a T10-T11 lesion. Initial conservative treatment was unsuccessful in all three cases. Anterior surgery was performed in all three cases. In two out of the three, posterior surgery was associated with the anterior approach. RESULTS: After surgery, the three lesions healed. DISCUSSION: Extensive discovertebral lesions during the course of rheumatoid spondylitis are well known. The authors discuss the pathophysiological mechanisms, the diagnostic difficulties of such lesions in patients referred for chronic spinal pain, and the choice of treatment. CONCLUSION: Surgical treatment was considered necessary in view of the mechanical solicitations of the mobile segment. A double approach, both anterior and posterior, gave good results and is advocated by the authors.

Adult↗

PubMed1997

Congenital pseudarthrosis of the tibia treated with free vascularized fibular graft.

Management of patients with deformities due to congenital pseudarthrosis of the tibia continues to be controversial. The use of free vascularized fibular grafts in the reconstruction of these deformities appears to be successful in this patient population but is not without potential for significant complications. Long-term evaluation, at least to skeletal maturity, is necessary to judge the success of any procedure done for any pediatric patient. This case illustrates the natural history of the vascularized free fibular graft for congenital pseudarthrosis of the tibia in a young child. Complications of this treatment modality did occur, including probable recurrence and fracture at almost 11 years post-index procedure. However, stable reconstruction leading to fracture union was achieved, and the patient has resumed full activities with little residual deformity.

Adolescent↗

PubMedDate not supplied

Conversion of hip joint pseudarthrosis to total hip replacement.

Forth hips in 35 patients were converted from pseudarthrosis to low friction total hip arthroplasty (LFA). Pain, function and range of motion were improved in most cases. Gait was improved and number of walking aids required were reduced in most cases. Abduction against gravity and straight leg raising were also improved. Limb length was restored in all but 9 cases. Two cases dislocated postoperatively. One was reduced and did well; the other had a trochanter avulsion with recurrent subluxation. Improvement of function is a prime indication for converting a pseudarthrosis to LFA whereas pain is not so significant a factor. This is a formidable procedure requiring a complete range of prostheses and instruments and complete familiarity with the technique of total hip replacement but the end results are gratifying.

Adult↗

PubMed2003

Removal of lumbar instrumentation for the treatment of recurrent low back pain in the absence of pseudarthrosis.

INTRODUCTION: Removal of spine instrumentation for the treatment of recurrent low back pain remains controversial in the absence of pseudarthrosis and when no obvious pain generators are present. It is our practice to offer these patients surgical exploration and removal of instrumentation. MATERIALS AND METHODS: Forty-five patients underwent an anterior and posterior lumbar spinal fusion. The removal of instrumentation was performed by the same surgeon and senior author of this paper (MRP). The reason for the revision surgery was recurrent low back and leg pain. All patients had a solid fusion based on a thorough surgical exploration of the fusion mass. Instrumentation was deemed either solid or loose at time of removal based on the purchase at the screw-bone interface. Final outcomes were determined using a functional and satisfactory questionnaire and compared between the two groups (Loose Instrumentation versus Solid Instrumentation). RESULTS: The majority of the patients in both groups would recommend the surgery to a family member (79% overall), would have the surgery again themselves (82%) and consider the surgery a success (77%). Pain was significantly decreased from pre-operatively to post-operatively and from pre-operative to final follow-up in both groups. The group of patients with loose instrumentation were significantly more likely to have a successful outcome than the group without loose instrumentation. CONCLUSIONS: This study indicates that the removal of instrumentation in the absence of pseudarthrosis is beneficial in the relief of low back pain and leg pain symptoms. Increased success rates were noted in patients with loose instrumentation. However, this classification was based on inter-operative inspection. Further studies of the ability to diagnose and predict success prior to surgery needs to be done.

Adult↗

PubMed2002

Iliofemoral arthrodesis and pseudarthrosis: a long-term functional outcome evaluation.

Reconstruction after the resection of pelvic tumors is a major challenge. It depends on many factors such as age, activity level, type of tumor, its adjuvant treatment, and the extent of the disease. The purpose of the current study was to analyze the functional and oncologic outcomes of patients who had an iliofemoral arthrodesis after resection of a pelvic sarcoma. Between 1981 and 1999, 20 males and 12 females with a mean age of 39.9 years (range, 10-71 years) had an iliofemoral arthrodesis, either as a solid fusion or primary pseudarthrosis, at one institution. The functional outcome was evaluated using the Musculoskeletal Tumor Society and the Toronto Extremity Salvage scores. At a mean followup of 97 months (range, 14-226 months), 15 of 32 patients were alive, all without disease. The radiographic union rate was 86%. The mean overall Musculoskeletal Tumor Society and Toronto Extremity Salvage scores were 64% and 48%, respectively. Patients with a primary solid fusion did functionally better compared with patients who had pseudarthrosis (Toronto Extremity Salvage Score, 76%; Musculoskeletal Tumor Society Score, 71% versus Toronto Extremity Salvage Score, 52%; Musculoskeletal Tumor Society Score, 25%). Biomechanical analysis showed that the loss of motion in the hip is well-compensated. The authors conclude from this series that iliofemoral reconstruction after resection of a pelvic sarcoma provides acceptable and durable long-term results, not only from the oncologic, but also from the functional perspective.

Adolescent↗

PubMed1987

Free vascularized fibular grafts in the treatment of congenital pseudarthrosis of the tibia.

Five patients with congenital pseudarthrosis of the tibia treated by a free vascularized fibular graft are described. Follow-up evaluation ranged from 15 to 81 months, with a mean of 40 months. Bony union was attained in three of five cases as determined roentgenographically. The remaining two cases failed to attain bony union. All cases except one, who was treated with a below-knee amputation, subsequently attained bony union. However, four cases had five fractures after bony union. We discussed unsolved problems regarding the free vascularized fibular graft and fracture after bony union.

Child↗