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At least 1,297 records · Page 72Linked to original sources
PubMed1995

[Femoral loosening of total hip prosthesis caused by pseudarthrosis resulting from trochanterotomy].

PURPOSE OF THE STUDY: This survey of 48 cases of trochanteric non-union in THR showed that this complication had not only functional consequences (one patient out of three complains of some instability and mild pain) but may also lead to stem loosening (3/48) through an original mechanism. The movements of the trochanter produce wear debris, mainly from the broken metal wires fixing the trochanter (and from rubbing of the cement on the femoral side of the osteotomy). These debris create an osteolytic granuloma between the proximal lateral endocortex and the cement, which extends progressively to the distal tip of the stem. MATERIAL AND METHODS: A continuous series of 446 cemented Charnley type prostheses by the trans trochanteric approach showed 48 trochanteric non unions (11 per cent) which were examined at an average follow up of 6.5 years. Six patients were reoperated for important hip instability. Ten who suffered only from moderate instability were not reoperated on. 32 were asymptomatic and therefore where not reoperated, but 3 of them suffered from severe femoral loosening after 6 years and required revision. RESULTS: These cases of loosening due to trochanteric non union were characterized by: clinical patterns: they occurred only after 6 years, in active patients under 50; radiological aspects: osteolysis was initially limited to the lateral cortex (without any calcar resorption or radio lucency around the cup) analysis by electronic microscopy of the granuloma (harvested at revision) showed metallic debris (under 1 mu) inside macrophages, with some cement particles (secondary to the loosening). DISCUSSION: Mechanism of loosening These cases of loosening differ from those due to granuloma caused by wear debris of PE and from granulomas resulting from deterioration of the cement around the femoral stem, which both occur only much later with the Charnley prostheses. In our consecutive series of 32 cases of Charnley THR in young active patients with an average follow up of 9.5 years, the only cases of femoral loosening observed were related to trochanteric non unions. Hyposolicitation by trochanteric non union does not lead either to bone resorption or to stem loosening, as we could notice in a series of moderately active patients over 60 with loose non unions. Loosening due to trochanteric non unions was only observed in active patients with tight non unions, as the patient's activity and contact of the surfaces increase rubbing and wear of metal wires. Prevention of trochanteric non union. Despite attentive care to fixation of trochanter there is an unavoidable percentage of non union even in simple cases (3 to 4 per cent according to Charnley). Therefore we advocate this technique only when a large exposition is necessary (revisions, THR for dislocation etc..) CONCLUSIONS: Trochanteric non union may lead to stem loosening after 6 years in active patients under 50. Therefore we recommend: to restrict the use of the trochanteric approach to some difficult THR: revisions, prostheses for dislocation, etc... to reoperate patients under 50 with a trochanteric non union: if it is clinically symptomatic if a progressive granuloma of the lateral cortex, even though asymptomatic, appears.

Adult↗
PubMed1995

[Scaphoid pseudarthrosis and capitate fracture].

Two successive injuries to the same wrist of a patient led first to a scaphoid non-union and second to a capitate fracture. The case history, treatment and medicolegal implications are discussed.

Accidents, Occupational↗
PubMed1994

[Change in the treatment method of infected pseudarthrosis with bone loss of the tibia].

AIM OF INVESTIGATION: The treatment of nonunions complicated by infection and bone loss is divided into two stages. Having calmed down the infection by stabilizing, removal of infected and necrotic tissue and local antibacterial measures, the bone loss has to be filled up. Bridging the gap by means of autogenous cancellous bone grafting is complicated by a high rate of refractures depending on the length of bone loss. Therefore after changing the method and using the Ilizarov procedure it is of interest, whether this method offers advantages. Our experience is to be reported and discussed. METHODS: According to the clinical course two groups of patients with nonunions of the tibia complicated by infection and bone loss were compared. 25 previously evaluated patients of the years 1980/81 whose tibial bone loss was bridged by cancellous bone grafting (1st group) were compared with 16 patients who were treated by the Ilizarov method from May 1990 to October 1993 (2nd group). The average age was nearly the same (32.6/32.9 years). In the first group the average of bone loss measured 4 cm, in the second 7.8 cm. The number of initial operations to eliminate infection and the duration of fixator application from the beginning of bridging bone loss were compared as well as early and late complications, especially the rate of refracture and reinfection. RESULTS: 1.2 operations were needed to eliminate infection in the first group, in the second only one was necessary. The handling of the Ilizarov device is more difficult and needs training. The higher rate of early complications at the beginning decreased with increasing experience. The average of fixation time could be reduced by about ten days per cm of bone loss using the Ilizarov technique. By segmental transport new cortical bone is generated which surpasses cancellous bone grafting in regard to stability. This seems to be an important reason that refracture did not occur in the second group. Furthermore, reinfection could be avoided up to now obviously due to sufficient segmental resection of infected and necrotic tissue. Limited stores of autogenous cancellous bone are not to be feared. The total number of operations can be reduced. At the docking side early single cancellous bone grafting is recommended.

Adolescent↗
PubMedDate not supplied

[Treatment of pseudarthrosis of the long bones using the Ilizarov method in children].

In the period 1987-1993, 13 patients were treated for both infected and non-infected long bone pseudoarthrosis by Ilizarov method. The records and radiographs of nine boys and four girls, with the age ranging from 7 to 16 years, with an average of 12.3 years, were reviewed. All but one concerned the tibia. In one case the pseudoarthrosis was localized in the humerus. Ten were infected. Ten had bone loss, all in the tibia, 2.5 to 8.0 cm in the extension of. All the results were considered good and the complications observed were few and not related with the treatment.

Adolescent↗
PubMed1995

[Treatment of femoral and tibial septic pseudarthrosis by internal lengthening. Apropos of 24 cases].

Twenty two patients aged 18 to 47 years were treated for 24 infected bone defects and nonunions (6 femora and 16 tibiae) by radical resection of the necrotic bone and distraction osteogenesis techniques to regenerate the excised bone. Nonunion, infection, limb shortening, deformity, and osteoporosis were all addressed simultaneously. All patients underwent either bifocal or trifocal internal lengthening by bone transport technique of sliding a bone fragment, producing distraction osteogenesis behind it until the defect was bridged. The mean bone defect was 8.2 cm, with a range up to 16 cm. Eradication of the infection was achieved in all cases prior to the removal of the fixator. Problems with union requiring bone graft augmentation were encountered in three patients. One patient, who sustained a refracture, underwent an amputation. The mean time to union was 4.4 months, if the time was taken from the day the intercalary segment came in contact with the targed segment. Deformity and length inequality were corrected successfully in the majority of the patients. The bone result was excellent in 15 cases, good in 7, fair in one, and poor in one. The functional result was excellent in 11 cases, good in 8, fair in 3, and poor in 2. Distraction osteogenesis treatment seems to be superior to any other method used for treatment of infected bone defects and nonunions, especially in terms of eradication of osteomyelitis and quality of bone union. However, the ability to achieve excellent bone result in even the worst infected bone defects and nonunions does not guarantee a favourable functional result, unless the patient has an acceptable neurovascular status.

Adolescent↗
PubMed1993

[Intermediate results in treatment of scaphoid pseudarthrosis and fracture with the Herbert screw].

The Herbert screw is a self-cutting headless screw that is designed to effect interfragmentary compression on being screwed in and is suitable for scaphoid surgery besides being useful also for other purposes. Although the Herbert screw is biomechanically inferior in many respects to the spongiosa screw, prognosis is impressively improved in scaphoid surgery (in pseudarthroses and fractures) by implanting the Herbert screw. It replaces the Matti-Russi plasty and is used in proximal, dislocated medium-positioned and unstable fractures. 73 scaphoid pseudarthroses and 27 fractures were treated with the Herbert screw between 1989 and 1991 at the Dept. of Orthopaedics at the University of Heidelberg. In 46% of problematic indications successful healing was achieved in more than 90% of the cases. However, surgical technique is complicated, requiring a certain amount of practice to keep iatrogenic traumatisations as low as possible. In the treatment of pseudarthroses special attention must be paid to careful and extensive sclerosis resection. Although the Herbert screw is screwed in through the articular surface, the procedure does not necessarily imply an accelerated development of arthrosis.

Adolescent↗
PubMed1994

[Bone repair in pseudarthrosis after arthrodesis of the upper ankle joint].

Delayed union or non-union of ankle arthrodesis is a common problem and revision arthrodesis is necessary in those difficult cases. Three cases are presented, in which a non-union after tibiotalar or tibiacalcanear fusion could be treated effectively with a bone graft taken from the anterior cortex of the distal tibia or from the anterior iliacal spine. The bone graft was fixed proximally with a screw. Distally the graft was inserted in an slot gouged into the talus or the calcaneus respectively with or without screw fixation. Postoperative care included short-time external fixation and immobilisation with a shortleg weight bearing cast. We conclude that the technique of a sliding tibiotalar graft can be used for effective treatment of non-union following ankle arthrodesis.

Adult↗