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The authors report the results of studies on the thiamine and pyruvic acid content in the urine of 170 individuals (34 healthy persons and 136 patients with no union of fractures and pseudarthrosis). In patients with nonunited fractures and pseudarthrosis a deficiency of vitamin B1 is observed.
Congenital anterolateral bowing of the lower leg usually is a symptom of (impending) fracture because of congenital pseudarthrosis. This article reports a case of anterolateral bowing of the lower leg that is characterized by spontaneous correction and combination with duplication of the hallux. A review of the literature showed 10 comparable cases. This article is the first report on the magnetic imaging of this entity and describes its differentiation from congenital pseudarthrosis.
Results of subtalar arthrodesis performed by the Batchelor method were reviewed in thirty-four feet of twenty-two patients who had an average follow-up of thirty-nine months. The pseudarthrosis rate was 41 per cent, which is considerably higher than that reported for the Grice extra-articular arthrodesis. Three feet had a recurrence of deformity later than one year postoperatively. Two factors seemed related to the high incidence of pseudarthrosis: the parallelism of the axis of the graft to the axis of the subtalar joint and the cortical nature of the graft.
STUDY DESIGN: A retrospective comparison of three different types of bone grafts for posterior spinal fusion in adolescent idiopathic scoliosis. OBJECTIVE: To determine the efficacy of bone marrow and demineralized bone matrix as a bone graft substitute for spinal fusion. SUMMARY OF BACKGROUND DATA: Several reports have documented a high morbidity associated with harvesting autologous iliac crest bone graft (ICBG) for spinal fusion. Composite bone graft consisting of demineralized bone matrix and aspirated bone marrow may reduce the morbidity and still retain the osteoinductive properties of iliac crest autograft. METHODS: Three different bone grafting techniques were used by a single surgeon in 88 consecutive patients who had posterior spinal fusion for adolescent idiopathic scoliosis. Segmental instrumentation with dual-rod fixation was used in all cases. Selection of type of graft was determined historically by the time when the operations were performed. Autologous ICBG was used in Group A, freeze-dried corticocancellous allograft in Group B, and composite graft of autologous bone marrow and demineralized bone matrix in Group C. Seventy-seven patients were reviewed, with a minimum of 2 years' follow-up (mean, 3 years 7 months; range, 2 years-9 years 5 months). Radiographs were assessed for pseudarthrosis and loss of correction of 10 degrees or more. Loss of 10 degrees of correction has been previously identified as an indicator of potential pseudarthrosis or fusion instability. Both of these criteria were used to compare success of fusion. RESULTS: Failure caused by pseudarthroses was seen in two patients (2.6%), one in Group A and one in Group B. Eleven patients lost greater than 10 degrees of correction, but only one demonstrated pseudarthroses. The 13 patients with pseudarthroses or loss of correction constitute the failure group for purposes of graft assessment. The failure rate was 12.5% in Group A (ICBG), 28% in Group B (freeze-dried corticocancellous allograft), and 11.1% in Group C (composite graft of autologous bone marrow and demineralized bone matrix). Eliminating patients with crankshaft phenomenon did not substantially change the results. There was no morbidity associated with bone marrow aspiration. CONCLUSIONS: Fusion rates were comparable for GroupA (ICBG) and Group C (composite graft of autologous bone marrow and demineralized bone matrix). The composite graft is our preferred graft for fusions in adolescent idiopathic scoliosis.
Author reports on a technical fault during Matti--Russe's operation. The corticospongious graft was inserted instead of the pseudarthrosis, in the scaphoid-trapezial joint. Because of the scaphoid-trapezial ankylosis developed, the persistent pseudarthrosis and the degeneration in the carpal bones the freeing of complaints could be reached only by intercarpal arthrodesis and wrist denervation, according to Wilhelm.
AIM: The management of pseudarthrosis remains a challenge. Several in vivo animal and controlled clinical studies have demonstrated that low-intensity pulsed ultrasound can influence fracture healing. METHODS: A prospective longitudinal design was used. Fifteen patients (12 males and 3 females; mean age 35.5+/-12.9, range 18 to 60), all amateur athletes, under treatment for pseudarthrosis at different sites (average fracture age: of 336.6+/-60.1 days) were treated with a single 20 min daily application of low-intensity pulsed ultrasound (frequency 1.5 MHz and intensity 30 mW/cm2). All patients underwent clinical examination and plain radiography at the beginning of treatment and were followed up clinically and radiographically at 4, 8, 12, 16, 20 and 24 weeks until the fracture healed. RESULTS: All fractures healed with a mean healing time of 94.7+/-43.8 days. CONCLUSION: Low-intensity pulsed ultrasound is effective in the management of long standing fracture non-unions. Prospective randomized studies are needed to confirm the value of this modality of treatment.
OBJECTIVES: The effectiveness of open reduction and plate fixation combined with autogenous bone grafting was assessed in the treatment of humeral diaphysis pseudarthrosis. METHODS: Twenty-four patients (16 men, 8 women; mean age 44 years; range 28 to 64 years) were operated on for humeral pseudarthrosis. Of these, 16 patients and eight patients had had previous surgical and conservative treatments, respectively. Surgery was performed after a mean of 10.8 months (range 7 to 21 months) following the initial treatments. Preoperatively, none of the patients had infected nonunion, a bone defect greater than 4 cm, and radial nerve injury. Treatment included open reduction and plate fixation combined with autogenous bone grafting. The plate was secured with at least four screws (8 cortices) both proximally and distally. The mean follow-up was 40 months (range 28 to 60 months). The range of motion of the shoulder and elbow was evaluated according to the criteria by Rommens et al. Functional evaluations were made according to the criteria by Stewart and Hundley. RESULTS: Union was achieved in all the patients after a mean of 19 weeks (range 14 to 26 weeks). Shoulder range of motion was excellent in all the patients. Elbow range of motion was excellent in 22 patients and moderate in two patients. Functional results were excellent in 20 patients and good in four patients. Deep infection, nonunion, malunion, implant failure, or permanent nerve injury did not occur in any of the patients. Two patients had transient radial nerve palsy. CONCLUSION: Treatment with open reduction and plate fixation combined with autogenous bone grafting is a safe and effective option in humeral pseudarthroses, particularly in cases without infection, bony defect, and deformity requiring correction.
Imaging studies and operative records of 55 patients who had undergone lumbar pseudarthrosis repair were studied, providing a total of 85 surgically documented pseudarthroses. Preoperative imaging studies were carefully analyzed for the anatomic characteristics of the involved levels and the morphology of the fusion mass. The pseudarthroses were found to fall into four distinct morphologic categories: atrophic, transverse, shingle, and complex. The atrophic pseudarthrosis type was noted to be strongly associated with the presence of intact facet joints or spinal hardware. This retrospective analysis indicates that stress shielding provided by intact facet joints or spinal implants may contribute to graft atrophy in certain patients. The classification scheme proposed may be useful in future analyses of different fusion techniques in determining the various causes of this surgical complication.
A retrospective review was performed to investigate patterns of spinal deformity associated with neurofibromatosis and the incidence of pseudarthrosis and curve progression after spinal fusion. Twenty-three of the 32 patients (72%) with spinal deformity had dystrophic curve patterns. The incidence of pseudarthrosis was 38% for the dystrophic group undergoing isolated posterior fusion. Their average curve progression was 12.7 degrees and required an average of 1.7 procedures to achieve solid posterior fusion. Kyphoscoliotic curves should be treated with combined anterior/posterior fusion.
The authors propose the association of two or more surgical methods in the treatment of aseptic pseudarthrosis of the tibia with the object of increasing the probability of union and reducing the period of disability. Based on the anatomo-pathological features of the pseudarthrosis, methods aimed at obtaining mechanical stability (fibula pro tibia, Küntscher) and methods which stimulate biological repair (decortication, transplants) are associated. The results obtained confirm the theoretical presuppositions, revealing a relatively short amount of time required for healing.
There is a growing consensus that the mechanism leading to extensive discovertebral destruction (type III) in most patients with ankylosing spondylitis relates to fracture and subsequent pseudarthrosis. We introduced the term "pseudopseudarthrosis" to describe (in our case) the occurrence of abnormal motion between 2 fused spinal segments, resulting in extensive discovertebral destruction without fracture or pseudarthrosis.
Beyond elimination of pain, the objective of surgical treatment of scaphoid pseudarthrosis is the prevention of otherwise inevitable arthrosis of the wrist. In a follow-up of twenty-five patients over at least ten years post-operatively, the rate of union, but above all, the development of carpal instability and arthrosis was investigated. In the healed scaphoid, instability did not increase, although signs of arthrosis were found in almost all patients. As a rule, the degree of arthrosis was more pronounced in those cases with persisting subluxation of the lunate and DISI pattern of instability. Consequently, simultaneous correction of lunate subluxation via ligament reconstruction must be recommended when scaphoid pseudarthrosis is to be treated effectively. Late results of this modified procedure are not yet available though.
We evaluated the residual deformity and late treatment of thirty-four hips of thirty-one children who had had septic arthritis when they were less than one year old. The hips were classified into four groups on the basis of radiographic changes. Type-I deformity (five hips) involved transient ischemia of the epiphysis, with or without mild coxa magna, and these hips did not need reconstruction. Type-II deformity (eleven hips) included deformity of the epiphysis, physis, and metaphysis, and these hips needed an operation to prevent subluxation; the goals of the operation included improvement in acetabular coverage, improvement in abductor efficiency by epiphyseodesis or transfer of the greater trochanter, and equalization of limb-length discrepancy by epiphyseodesis of the contralateral limb. Type-III deformity (five hips) involved malalignment of the femoral neck, with extreme anteversion or retroversion or with a pseudarthrosis of the femoral neck that necessitated a realignment osteotomy of the proximal part of the femur or bone-grafting of the pseudarthrosis. Type-IV deformity (thirteen hips) included destruction of the femoral head and neck, with persistence of only a remnant of the medial base of the femoral neck. In the hips that had a Type-IV deformity, the complex clinical problems, which included severe limb-length discrepancy and incompetent articulation of the hip, necessitated operations such as Pemberton osteotomy, trochanteric arthroplasty, arthrodesis, epiphyseodesis of the contralateral limb, and lengthening of the ipsilateral tibia. The functional result was satisfactory in all five hips that had a Type-I deformity, in seven of eleven that had a Type-II deformity, in three of four that had a Type-III deformity, and in only four of thirteen that had a Type-IV deformity.
We reviewed the results, after follow-up ranging from twenty-three months to six years, in thirty-four patients who were treated during childhood for hematogenous osteomyelitis of a major long bone complicated by sequestration of a portion of the diaphysis and by pseudarthrosis or segmental bone loss, or both. Of the thirty-four lesions, twenty-four were in the tibia, eight were in the femur, and two were in the humerus. In twenty-three patients (Group I), the infection was still active, while in the other eleven (Group II), it was quiescent at the time of admission to the hospital. In nine of the patients in Group I (four tibial and five femoral lesions), an involucrum bridged the osseous defect, indicating that the periosteal tube had not been destroyed. In these nine patients, sequestrectomy and débridement, appropriate antibiotic therapy, and prolonged immobilization in a plaster cast resulted in healing of the defect without recurrence of the infection. In the remaining fourteen patients (twelve tibial and two femoral lesions), there was no periosteal new-bone formation, and operative treatment consisted of two stages: the first, to resolve the infection, and the second, to heal the osseous defect with corticocancellous iliac grafts. In the eleven patients in Group II (eight tibial, one femoral, and two humeral lesions), there were no involucra. All of these patients were treated with cancellous bone grafts and prolonged immobilization. In twenty-two of the thirty-four patients (thirteen in Group I and nine in Group II), there were varying degrees of angular deformity at the pseudarthrosis, necessitating correction by manipulation when the plaster cast was applied postoperatively (ten patients), by fibular transposition (six patients), or by fibular osteotomy in addition to manipulation (six patients). Excluding complications specific to the fibular transfer procedure, the complications in the Group-I patients (six recurrent postoperative infections, one fracture of the graft, and one non-union of a fibular strut graft) were approximately as frequent as those in the Group-II patients (one failure of fusion and two fractures of the graft). Operative treatment resulted in healing of all but one tibial lesion, in a patient who nonetheless had good function at follow-up. Of the seven limb-length discrepancies of 2.8 centimeters or more, by the latest follow-up two had been treated uneventfully: one by femoral and the other by tibial lengthening.(ABSTRACT TRUNCATED AT 400 WORDS)
A retrospective study of 203 fractures of the tibial shaft, treated with ASIF-plate osteosynthesis between 1975 and 1986, revealed that the rate of osteitis and pseudarthrosis in closed and first-degree open fractures compares favourably with nationwide figures. The same applies to the duration of disability. Early treatment of osteitis, delayed union and pseudarthrosis in all cases led to complete recovery. Moving to modern hospital premises appears to have lowered the prevalence of infectious complications. Despite several negative prognostic factors, the results showed that ASIF-plate osteosynthesis if correctly performed on the right indication, is still the treatment of choice for a large group of patients with fractures of the tibial shaft.
A series of 23 reosteosynthesis of the tibial shaft, primarily treated with a plate osteosynthesis, is presented. More than 60% of the fractures were open and more than 75% were of the type B or C of the AO-classification. In these fracture types, the apposition of the fracture fragments is incomplete (type B) or totally absent type (type C) after closed reduction. A pseudarthrosis was responsible for the reosteosynthesis in 65% of the patients and an implant failure in more than 40%. The second intervention was performed after an average time of 8.1 months. In 12 of the 23 patients a second plate osteosynthesis, in 7 patients an external fixation and in 4 an endomedullary nailing was carried out. The time between the second stabilization and the bone healing was 5.9 months. The functional end results were excellent or good in 70%. Fragment necrosis in comminuted fractures or after imprudent dissection of the fracture site leads to important bone healing disturbances after plate osteosynthesis. When a delayed union or developing pseudarthrosis can be suspected, a quick changement of procedure should be planned. A new plate osteosynthesis combined with a transplantation of cancellous bone seems to be the most appropriate procedure. In definite cases, an endomedullary nailing or external fixation is desirable.
Fifty consecutive patients had posterior spinal fusion using only graft from bone banks. They were studied retrospectively in order to determine the pseudarthrosis rate, the quality of fusion mass obtained, the rate of infection, volume of blood lost, and operative time. The results showed that it is likely that the graft material used is not as important as the fusion technique. Strict adherence to facet obliteration, posterior element decortication, thorough removal of all soft tissue, and stable, well-planned instrumentation are probably the most important factors in preventing pseudarthrosis. With the complications associated with iliac crest graft and the potential benefits of reduced operative time and blood loss, use of allogeneic bone appears justified.
Follow-up of 197 patients with scaphoid nonunion treated by Russe I and Russe II bone grafting procedures showed that in longstanding cases with pseudarthrosis and in cases with severe necrosis bony union is often not achieved. The reason for this lack of success is the bad vascularity of the damaged scaphoid. In these cases (25 cases performed over 19 months) with an unfavorable operative prognosis we have inserted into the scaphoid after resection of the pseudarthrosis or the necrotic bone, a corticocancellous graft from the iliac crest, isolated on its vascular pedicle. The vascular pedicle has been anastomosed under the microscope to the radial artery and one of the accompanying veins. This procedure guarantees a much better vascularity of the bone graft. Our results in the 25 cases are very encouraging. Possible complications and their avoidance are pointed out. This new operative technique should not replace other common procedures but it might be the treatment of choice in selected cases.