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PubMed1993

[Pseudarthrosis of the uncinate process].

Ten cases of nonunion of the hook of the hamate were observed, eight of which had occurred during athletic activity. The mean age was 31.1 years and the mean length of time between the accident and diagnosis was 8.8 months. Diagnosis was most often confirmed by CT scanning, which, represents the examination of choice. In all cases, surgical treatment was applied using the same technique and the same surgeon. Results were evaluated according to resolution of pain, movement, strength of grip and return to former level of athletic activity. Results were very good in six patients and good in two others who returned to previous activity. One patient had only a fair result with resolution of pain. One case was a failure with persistence of pain and ulnar paralysis.

Adult↗
PubMed1994

[Osteosynthesis of ulna pseudarthrosis after Monteggia equivalents].

Stable internal fixation of the ulna is often followed by nonunion if the radial head has been resected in primary treatment of monteggia equivalents. Many patients have to undergo several operations before solid union is achieved. The reason for these disappointing results is the complex instability caused by the absence of the radial head. Our experience led us to use combined osteosynthesis with both an intramedullary compressive screw and a lateral plate. Even secondary replacement of the radial head by a spacer seems to be beneficial in the avoidance of fatigue fractures which might otherwise be caused by screw tracks. Secondary resection of the radial head practically always leads to synostosis. The results of primary treatment of monteggia fracture by the form of osteosynthesis described have proved successfully.

Adult↗
PubMed1995

[Pseudarthrosis and delayed union of the distal phalanx of the long fingers. Apropos of 13 cases].

PURPOSE OF THE STUDY: The authors present 13 cases of delayed or non-union of the distal phalanx of the long fingers treated surgically. MATERIAL AND METHODS: The patients were all men aged from 41 years to 60 years. The involved digits were 4 second, 2 long, 5 ring, and 2 little fingers. The operated side was the right side 5 times, the left one 8 times, the dominant one 4 times. Ten cases were due to inadequate treatment of the initial fracture. The three others cases had no clear explanation. Three types of incisions were used: transverse distal, lateral or an extended one combining the two previous. Bone stabilisation was made either, by longitudinal K wires or with a small cancellous screw. In 7 cases, bone grafting was needed. RESULTS: Bone healing was obtained in 9 cases in an average time of 9 weeks. Further procedures included: 2 distal amputations after septic conditions, 2 removals of distal bone fragment and 2 fusions of the distal interphalangeal joint. Overall results evaluated by the patients themselves were fair, including 2 excellent, 6 good (but 2 after distal interphalangeal joint arthrodesis), 2 mild (1 after distal interphalangeal joint arthrodesis), 1 poor and 2 failures. DISCUSSION: The type of skin incision was chosen according to the bone condition; distal in cases of fibrous nonunion when fibrous tissue removal and bone grafting were needed. Neither the type of bone stabilisation (pinning or screwing) nor the donor site of bone grafting influenced the final result. CONCLUSION: The authors would like to stress the importance of an adequate treatment of finger injuries in a emergency situation, considering the difficulties to restore secondarily a satisfactory functional outcome.

Adult↗
PubMed1996

[Role of intramedullary nailing in pseudarthrosis and malalignment].

Intramedullary stabilization can provide fast bone consolidation in cases of delayed fracture healing and hypertrophic non-unions. The indication for intramedullary nailing must be exactly adapted to the individual situation. An analysis of our own cases revealed bony healing in hypertrophic non-unions of femoral shaft fractures in 93% and in 94% of tibial shaft fractures after reamed intramedullary nailing. In selected cases of axial or rotational deformities or length discrepancy of the femur and the tibia, a correction osteotomy can be performed with intramedullary nailing. If it is necessary to expose the non-union and in axial or rotational deformities a rotation-stabilizing plate can be applied in addition to the intramedullary nail.

Adult↗
PubMed1997

[Bone marrow in patients with pseudarthrosis. A study of progenitor cells by in vitro cloning].

PURPOSE OF THE STUDY: The recent observations that osteoblasts develop from a stem cell found in the medullary stroma suggest that, as already suspected in classical histological studies, many consolidation mechanisms are based on bone marrow. Since cells characteristics can now be studied in tissue culture, it has become possible to investigate the activity of the bone marrow in non union. The working hypothesis for this study was: if the bone marrow plays a part in bony callus formation, bone marrow from non union site should manifest anomalous activity whatever the origin of the focus sampled. Therefore, the aim of this study was to seek in vitro, using cell cloning techniques, anomalies of bone marrow from non union site. MATERIALS: The study characterizes the bone marrow from 35 non union sites, not only with respect to the medullary stroma but also the hematopoietic compartment. In this study, we look for systemic anomalies which could explain susceptibility to non union, we also compare in vitro activity of bone marrow taken from non union with others samples taken from the iliac crest of the same patient. METHODS: The cell density in the bone marrow in these sites was studied in vitro with material taken from the non union site. Samples were taken by aspiration with a trocar located by image intensification. Assays of CFU-GM were chosen to quantify the hematopoietic activity of the marrow, and of CFU-F to quantify stroma cells activity. Cell densities in the non union site were compared to those in patients' own iliac crests, and also to iliac crests densities of a control population of bone marrow donors. RESULTS: The bone marrow of non union site contained low levels of progenitor cells. Especially surprising was that progenitors were also sparse in the bone marrow of the iliac crest of patients with non union, compared with control bone marrow donors. In several cases, certain general factors are probably responsible for the abnormally low levels of progenitor cells, not only in the non union site, but also in the iliac crest.

Adolescent↗