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PubMed1997

Pseudarthrosis after postoperative wound infection in the lumbar spine.

This retrospective investigation attempts to define the incidence of fusion success after postoperative infection after a posterior lumbar fusion, as well as which risk factors may adversely affect arthrodesis after successful debridement. At an average follow-up of 37 months, 18 of 29 patients (62.1%) had a successful arthrodesis. Eighty-seven percent of patients whose fusion excluded the sacrum had a solid arthrodesis, compared with only 36% of those fusions including the sacrum. The fusion rate in female patients was 33.3%, compared with 82.4% in male patients. The rate of fusion with allograft bone was 17.2 versus 83.3% with autograft bone. Female sex, the use of allograft bone, and extension of the fusion mass to the sacrum significantly increase the incidence of nonunion after a postoperative deep spinal wound infection.

Adolescent↗
PubMed1998

[Surgical treatment of scaphoid pseudarthrosis--long term outcome with the Herbert screws].

Between 1984 and 1993, 131 scaphoid nonunions were treated with iliac crest bone grafting and the Herbert-screw. 105 patients were followed between one and ten years with an average followup period of 4.5 years. Bony union was achieved in 93 patients with improvement of range of motion and grip strength. In 14 patients with DISI-instability, the angulation deformity was incompletely corrected with an average reduction of the scapho-lunate angle of eleven degrees. Limited athritic changes at the radial styloid were noted in 58%, intercarpal in 25% of the patients. Most frequent reasons for persistent nonunion were technical problems with the Herbert-screw.

Adolescent↗
PubMed1997

[Pseudarthrosis treated by percutaneous autologous bone marrow graft].

PURPOSE: This 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 looked for systemic anomalies which could explain susceptibility to non union. We also compare the in vitro activity of bone marrow taken from non union sites with that of samples taken from the iliac crest, of the same patient. MATERIAL AND METHODS: We included 6 groups: 26 cases of post-traumatic non union. 2 cases of non union following arthrodesis of the knee for infected prosthesis, 1 case of a non union of a tibiotarsal arthrodesis. 4 cases of regenerated illizarov extensions, which showed no evidence of ossification three months after operation, 2 cases of patients suffering from congenital abnormalities. Samples were taken from a population of 30 "bone marrow donors", to act as controls for the iliac crest samples. RESULTS: Cell density in the iliac crest bone marrow of non union patients is significantly lower than that of controls (p < 0.01). In the hematopoietic compartment of the bone marrow, the number of progenitors (GM-CFU) obtained after culture of iliac crest bone marrow is consistently lower for patients presenting a non union than for controls (p < 0.01). Only infection of non union site (4 cases) seems to be associated with an increase in GM-CFU in the iliac crest. The difference in the average number of F-CFU obtained after culture of bone marrow from non union patients and from controls is lower but is nevertheless significant. 14 of the non union patients have less than half the F-CFU observed as normal in controls and 10 of them yielded less than one quarter. Out of these ten patients, in whom non union was associated with a marked abnormality in the number of F-CFU in the iliac crest (less than one quarter of the total obtained from controls), in 8 cases were other factor or disease which could account for the abnormality such as age (2 cases), clear alcoholic intoxication (1 case), heavy smoking (2 cases), history of chemotherapy (2 cases), and Lobstein's disease (1 case). The values found in non union sites and extension regenerated fibrous tissue suggest that there are relatively few F-CFU to differentiate into fibroblasts. In 12 out of 35 patients studied, the bone marrow generated no F-CFU. Same patients have abnormal low levels of F-CFU obtainable from their iliac crest bone marrow. The number of GM-CFU in fracture site is also extremely low. No local increases in GM-CFU levels are seen in septic focuses. The population of F-CFU and GM-CFU vary with time, in the same patient, at the same site of aspiration. Higher levels of osteogenic activity are seen at the beginning of extension. CONCLUSION: This study suggests that problems related to consolidation may be linked with an overall reduction of bone marrow progenitor cells, as a result of some general physiological problem (chemotherapy, smoking, alcoholic poisoning).

Administration, Cutaneous↗
PubMed1992

Vascularized bone transfer for tibial pseudarthrosis. Part II: Vascularized bone and muscle transfers. Exclusive free fibular bone graft.

The techniques of vascularized transfer of a bone segment, or of revascularization of a conventional bone autograft by a pedicle or a microsurgical muscular flap represent one of the most significant advances made during the last years for the treatment of large bone defects of the tibia with associated skin injury. The authors present their experience with 16 cases, including 5 microsurgical transfers.

Adult↗
PubMed1991

Girdlestone's pseudarthrosis after removal of a total hip prosthesis; a retrospective study of 40 patients.

In case of irreversible failed total hip replacement, a Girdlestone operation is sometimes the obvious solution: excision of cement and prosthesis without attempting a new hip replacement. Reasons for not implanting a new prosthesis are severe loss of bone stock, the risk of recurrent infection, or poor general condition. A clinical follow-up study was performed on 40 patients who underwent a Girdlestone hip procedure using the following criteria: pain, walking distance and the use of a walking support. The mean follow-up was 4.9 years. Postoperatively 33 of 40 patients had less pain compared with the situation before the operation. Sixteen patients walked more than 500 m, 13 patients walked 200-500 m and 11 patients walked less than 200 m, of whom 4 were wheelchair bound. The objective result was good in 40% of the patients, moderate in 42.5%, and bad in 17.5%. Subjectively 62.5% were satisfied. A Girdlestone arthroplasty after loosening of the hip prosthesis was a satisfying solution in most cases.

Adult↗