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PubMed1992

Pseudarthrosis of the spine.

Pseudarthrosis remains the leading cause of failed spinal fusions. The common causes of this complication are inadequate surgical technique, excessive stresses across the fusion site, insufficient internal or external stabilization, and unrecognized metabolic abnormalities. Many radiologic techniques have been used to diagnose pseudarthrosis in the spine. Nonetheless, the diagnosis of a nonunion as well as the ability to correlate the nonunion with the patient's clinical symptoms remains a challenge. In treating a symptomatic pseudarthrosis, the surgeon should first attempt to identify those factors that contributed to the development of a nonunion. The approach can then either be exploration of the fusion mass with regrafting of the pseudarthrosis or extending a fusion to locations within the abnormal segment of spinal motion.

Diagnostic Imaging↗

PubMed1991

Nonunion and pseudarthrosis of fracture healing. A histopathologic study of 95 human specimens.

Forty-one human tissue specimens from fracture nonunions in extraarticular locations demonstrated a spectrum of clefts at the site of nonunion ranging from tiny microscopic spaces within the soft tissue of the nonunion to dominant clefts that completely separated the ends of the fracture. These latter specimens were examples of frank pseudarthrosis. The soft tissues lining the large clefts were often considerably eroded. Pseudarthrosis of fracture healing may be a late manifestation of more mobile nonunions that progressively tear apart. Fifty-four additional nonunion or pseudarthrosis specimens from former intraarticular fractures demonstrated the same sequence of changes occurring in 24 of the cases. However, 30 of the intraarticular fractures demonstrated no tissues of a fibrous nonunion, which could indicate that in such locations pseudarthrosis may exist from the date of the original fracture.

Bone and Bones↗

PubMedDate not supplied

[Aseptic pseudarthrosis of the tibial shaft: cause and treatment].

A consecutive series of 23 aseptic pseudarthroses of the tibial shaft is proposed. The aetiology of a pseudarthrosis of the tibia depends on the original fracture form, the associated soft tissue injury, the treatment technique and the surgical procedure. Twelve times the pseudarthrosis developed after a primary treatment with an external fixation device, 6 times after plaster cast immobilization, and 5 times after plate osteosynthesis. Fifteen times, the pseudarthrosis was hypertrophic, and 8 times hypotrophic. Sixteen pseudarthroses were treated with a plate osteosynthesis, 8 times in combination with a decortication and a cancellous bone grafting. Seven times, a closed intramedullary nailing was performed. Healing was achieved after an average time of 5.1 month. After plaster cast immobilization and external fixation treatment, the non-union is caused by a lack of stability in the fracture region; after plate osteosynthesis by a too extensive decortication, resulting in fragment necrosis. Stability and vitality in the fracture site are the principles in the treatment of the pseudarthrosis.

Adult↗

PubMedDate not supplied

Pseudarthrosis of the radius associated with neurofibromatosis. A case report.

A seven-year-old-boy with neurofibromatosis developed pseudarthrosis of the radius. After treatment by external electrical stimulation of the forearm failed, the pseudarthrosis was excised and the proximal and distal ends of the radius were osteotomized. The bone segments were reversed to correct the deformity and to place bone adjacent to the pseudarthrosis in contact with normal bone. This operation has not been described previously for this condition and, as in all previous reports, failed to produce union. Surprisingly, the excised pseudarthrosis showed no histologic evidence of neurofibroma or impaired osteoblastic function. The surrounding soft tissues may play an important role in the establishment and maintenance of the condition.

Child↗

PubMed1995

Congenital pseudarthrosis of the clavicle. Histologic examination for the etiology of the disease.

The etiology of congenital pseudarthrosis of the clavicle remains obscure. The authors treated a 5-year-old boy with this rare disease. Clinical history and radiographs confirmed the diagnosis. Surgical treatment of resection of the pseudarthrosis, autologous bone graft, and internal fixation with a small AO plate led to successful bone union. Histologic analysis of the pseudarthrosis showed that there were cartilaginous caps on the proximal and distal bony ends. The appearance of the cartilaginous caps were equivalent to that of developing physes. They were adding new bone to the bony ends, which also was confirmed by preoperative tetracycline labeling. These observations support the hypothesis that the pseudarthrosis is caused by failure of 2 ossification centers to fuse, as was previously proposed by others.

Child, Preschool↗

PubMed1976

[The plate-osteosynthesis of posttraumatic pseudarthrosis (author's transl)].

In 87 patients from a total of 90 a posttraumatic or postoperative diaphysal or epimetaphysal shaft-pseudarthrosis could be found. In 53 patients we used the plate-osteosynthesis (tension-, axial compression-, neutralisation-, bridge- and bilateral plates). In 24 patients this was combined with other procedures (decortication, resection of the fragments or the pseudarthrosis or surplus--callus, implantation of autogenous bone). Using plate-osteosynthesis in all cases of aseptic or defected pseudarthrosis we gained osseous stabilization and healing, with good function, as was shown by followup studies. In infected pseudarthroses (8 patients) several operations were necessery for complete healing. Successfull treatment of aseptic and infected pseudarthrosis is based on the correct indication as well as correct choice and application of the plate.

Bone Nails↗

PubMed1999

Descriptive analysis of tibial pseudarthrosis in patients with neurofibromatosis 1.

Five percent of individuals with neurofibromatosis type 1 (NF1) present with congenital long bone pseudarthrosis (PA). In large series, 50-80% of patients with congenital long bone PA also have NF1. Very little information exists on the natural history and pathogenesis of PA in NF1. This report is a descriptive analysis of a large series of patients with NF1 and tibial bowing or PA. Study A is a case-control study using the National Neurofibromatosis Foundation International Database (NNFFID). Eighty-five patients with PA were compared to a control group from the same database. There was a statistically significant male predominance of NF1 cases with PA (54 males to 31 females), compared to controls (85 males to 87 females) (chi2 = 4.0, P = 0.046, using a two-tailed test with Yates' correction). There was no significant difference in the clinical presentation of NF1 manifestations in NF1 patients with PA than in NF1 patients without PA. Of the affected individuals with PA, there were 24 de novo cases and 21 familial cases (9 through maternal and 12 through paternal inheritance). Questions that could not be answered by Study A were addressed by a partially overlapping case-series report, Study B, in which data on 75 cases ascertained through questionnaires completed by NF center directors were collected. From Study B we determined that half of the patients who had a fracture sustained it before age 2, and approximately 16% of the pseudarthrosis patients had an amputation. Our data indicate a male predominance and no parent-of-origin effect. Male gender may be a susceptibility factor for pseudarthrosis in NF1.

Adolescent↗

PubMed1987

Painful pseudarthrosis following lumbar spinal fusion: detection by combined SPECT and planar bone scintigraphy.

Twenty-six adult patients more than 6-months post-lumbar spinal fusion were studied. Flexion and extension radiographs showing motion or bone scintigrams showing focal areas of increased activity within the fusion mass were considered positive for pseudarthrosis. Patients were classified as either symptomatic or asymptomatic. Among the 15 symptomatic patients, scintigraphy had a sensitivity of 0.78 and a specificity of 0.83 which was superior to the 0.43 sensitivity and 0.50 specificity of radiography. Six of the 11 asymptomatic patients had focal areas of increased activity in the bony fusion mass, possibly reflecting painless pseudarthrosis. Planar imaging was substantially enhanced by SPECT in 14 of the 26 cases. It is concluded that for the patient who remains symptomatic after lumbar spinal fusion, bone scintigraphy with SPECT is of significant value in detecting painful pseudarthrosis.

Adult↗

PubMed1997

Application of extracorporeal shock-waves in the treatment of pseudarthrosis of the lower extremity. Preliminary results.

Between January 1991 and January 1996, pseudarthroses of the legs were treated prospectively in 48 patients by application of high-energy extracorporeal shock waves with an experimental device. The mean duration of pseudarthrosis was 12 months. On average, 2.4 surgical interventions had previously been performed. A total of 3000 impulses with an energy density of 0.6 mJ/mm2 was applied to the pseudarthrosis. Bony union was achieved in 60.4% of our patients after an average of 3.4 months. Failures were found especially in the atrophic types of pseudarthrosis as well as in congenital bone disorders like fibrous dysplasia or osteogenesis imperfecta. No serious complications were observed. Even after numerous surgical interventions high-energy extracorporeal shock-wave therapy showed a fair success rate. A higher success rate of this non-invasive method for the treatment of bony non-unions may be expected by applying strict selection criteria.

Adolescent↗

PubMed1984

Aseptic diaphyseal pseudarthrosis: treatment by rigid internal fixation.

The authors define their concepts with regard to nonunion of fractures and study the possible causes of aseptic diaphyseal pseudarthrosis in the 182 cases in their casuistics. They have found that the indication for osteosynthesis was incorrect in 34% of the cases and when it was correct, the technique was poor in 58%. The authors conclude that the risk of nonunion in fractures and nonconsolidation of pseudarthrosis can be minimished if there is: (1) correct indication with respect to type and level of fracture or pseudarthrosis; (2) choice of an appropriate internal fixation method; and (3) good achievement of the selected osteosynthesis.

Femoral Fractures↗

PubMed1982

[Pseudarthrosis of the clavicle - an unnecessary complication? (author's transl)].

The pseudarthrosis of the clavicle is a rare complication of trauma surgery. The pseudarthrosis is mainly situated in the two medial quarters of the bone. The stable plate-osteosynthesis is regarded as the best treatment in combination with an autologous bone grafting in cases of atrophic or defect-pseudarthrosis. From 1970 to 1981 20 patients were treated at the BG Unfallklinik Tübingen, indication, operative procedures and the results are given. A bony union was achieved in all cases.

Adolescent↗

PubMed2003

Pycnodysostosis associated with bilateral congenital pseudarthrosis of the clavicle.

We report the case of a 22-year-old woman with pycnodysostosis associated with bilateral congenital pseudarthrosis of the clavicle. The patient was first seen at the age of 19 years and had no symptoms during the 3-year follow-up period. The diagnosis of pycnodysostosis was made by typical clinical and radiological findings. Bilateral painless mid-clavicular mass and plain radiograms confirmed the diagnosis of bilateral congenital pseudarthrosis of the clavicle. Surgery was not performed for pseudarthrosis of the clavicles, just observation was preferred.

Abnormalities, Multiple↗

PubMed1988

Congenital pseudarthrosis of the forearm.

Congenital pseudarthrosis of the forearm is a rare condition in which traditional treatment methods have proven unsatisfactory. We report a case of congenital pseudarthrosis of the radius and ulna successfully treated by resection of the distal ulna and excision of the radial pseudarthrosis with replacement by an interpositional free vascularized fibular graft.

Child, Preschool↗

PubMed2000

[Treatment of pseudarthrosis of the carpal scaphoid bone by percutaneous pinning. Apropos of 74 cases].

From 1985 to 1997, 74 patients was operated of scaphoid non union at the Kassab Institute by a percutaneous pinning as described by Galluccio. The average age is 30 years with an extreme from 17 to 48 years. Union was obtained after an average of two years and six months. In 12 cases the delay was superior than three years. Functionally, pain is a constant cause of consultations and the majority of patients presented a reduction of the mobility sector (80%) and the strength of grasp (70%). Anatomically, it is particularly a pseudarthrosis stage II a of Alnot, and type I b of our classification. An immobilisation post-operative during one month is the rule. The analysis of results at an average of four years, revealed 91% of clinical recovery. Radiographically, the union is obtained in 89% of cases. Our fails (11%), are explained by an inadequate mounting and particularly by the length of pseudarthrosis. Compared to other means of synthesis, the percutaneous pinning of Galluccio, is an inexpensive technique, easily and rapid, which permit to obtain an interesting results particularly in the recent pseudarthrosis (evolution delay below three years).

Adolescent↗

PubMedDate not supplied

[Surgical treatment of congenital clavicular pseudarthrosis].

INTRODUCTION: Congenital pseudarthrosis of the clavicle is an extremely rare disease of unknown histogenesis. The method of treatment is still discussed controversely. CASES: Two cases of a congenital pseudarthrosis of the right clavicle were presented, revealing the typical clinical, radiologic and histopathologic features. Surgical treatment was performed at the age of 4 and 7 years, consisting of a partial resection of the bony ends of both segments of the clavicle, partial excision of the dense fibrous tissue lying within the defective area in the middle third of the clavicles by forming a continuous sleeve for interposing autogeneous spongiosa from the iliac crest and internal fixation with a Kirschner wire. Both cases showed a successful solid bone union in X-ray controls after 8 weeks. CONCLUSIONS: According to the histopathological findings we assume an abnormal ineffective chondral instead of an endesmal ossification resulting from a damage during embryogenesis as the underlying pathogenetic mechanism of congenital pseudarthrosis of the clavicle. Since chondral ossification proves to be ineffective also after birth, spontaneous bony union cannot be expected. Therefore, reconstructive surgery is the treatment of choice.

Bone Transplantation↗

PubMedDate not supplied

[High-energy extracorporeal shock-wave therapy (ESWT) in the treatment of pseudarthrosis].

PROBLEM: The success rate of high-energy extracorporal shock wave therapy in the treatment of non-unions in comparison to the "golden standard" surgery is still unclear. METHOD: In a prospective study, 3000 impulses with an energy density of 0.6 mJ/mm2 were applied with an experimental device to the pseudarthrosis in 52 patients. RESULTS: The mean duration of pseudarthrosis was 13 months. A mean of 2.5 surgical interventions had already been performed. Bony union was achieved in 52% of our patients after an average of 3.3 months. Failures especially were found in the atrophic type of pseudarthrosis as well as in congenital bone disorders like fibrous dysplasia or osteogenesis imperfecta. No serious complications were observed. CONCLUSIONS: Even after numerous surgical interventions high-energy extracorporal shock wave therapy as a noninvasive method for the treatment of bony non-unions showed a fair success rate. A higher success rate can be expected by strict selection criteria.

Adolescent↗

PubMed2002

Intramedullary fixation and bone grafting for congenital pseudarthrosis of the tibia.

Eleven consecutive patients with 12 congenital pseudarthroses of the tibia had intramedullary fixation and autogenous bone grafting as an initial treatment. None of these patients had previous surgeries or other concomitant procedures. The average age of the patients at the time of surgery was 2.5 years (range, 0.5-8.8 years). Four patients achieved initial union after the first index operation; two patients achieved union with no additional procedures, and three patients required an exchange intramedullary fixation for persistent nonunion after refractures that eventually healed. Seven patients did not achieve union after the first index operation; four patients achieved healing after multiple procedures including repeat intramedullary fixation, free vascularized fibular grafting, or both; two patients eventually had below-knee amputations after multiple procedures failed; and one patient did not achieve union of the pseudarthrosis. The important factors leading to failure of union were the distal location of the tibial pseudarthrosis and the presence of concomitant pseudarthrosis of the fibula.

Bone Transplantation↗

PubMed1998

Vertebral pseudarthrosis in the osteoporotic spine.

STUDY DESIGN: Radiologic and operative findings of intravertebral cleft in the osteoporotic spine were investigated and the pathomechanism discussed. OBJECTIVES: To clarify the pathologic features of the intravertebral cleft. SUMMARY OF BACKGROUND DATA: Intravertebral "vacuum" cleft is one of the common radiographic findings in the osteoporotic spine. It is thought that the cleft is a rare lesion of an ununited fracture, or pseudarthrosis. Evidential findings of the disease, however, have never been reported. METHODS: Simple bone grafting was performed in five cases (average age, 76.8 years) of thoracolumbar intravertebral cleft in osteoporotic spine in patients who had been suffering from prolonged pain of the back or leg. Preoperative radiologic evaluation using flexion-extension radiograph and magnetic resonance imaging was performed in all patients. At operation, the cleft and the components of the structure were macroscopically and microscopically observed. The fluid content in the cleft was biochemically analyzed. RESULTS: In all patients, preoperative flexion-extension radiographs showed intravertebral instability at the location of the clefts that indicated gas density in three cases and water density in two cases. Magnetic resonance imaging showed that, for the most part, the cleft was low intensity on the T1-weighted image and high intensity on the T2-weighted scans, regardless of the radiographic findings. At operation, abnormal movement was observed at the cleft of the affected body, which was covered with hypertrophic membrane. The serous fluid within the cleft was aspirated before the excision of soft tissue. The thick membrane was excised and showed that the cleft was lined by smooth fibrocartilaginous tissue and the great degree of motion between the fracture ends that is consistent with the pathologic appearance of pseudarthrosis. CONCLUSIONS: The unstable cleft in the affected vertebral body of the osteoporotic spine with magnetic resonance findings of low intensity on the T1-weighted scans and high intensity on the T2-weighted scans suggests that the cleft is a false joint lined by fibrocartilaginous tissue with notable movement consistent with pseudarthrosis.

Aged↗