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PubMed1988

The pathogenesis of extensive discovertebral destruction in ankylosing spondylitis.

The study of extensive discovertebral destructive lesions in ankylosing spondylitis has been largely limited to isolated case reports or clinicoroentgenologic reviews with little pathologic correlation. In eight specimens of the spine collected from 35 patients with ankylosing spondylitis showing extensive discovetebral destructive lesions, a detailed pathologic study revealed a consistent picture of complete or near-complete destruction of the disc-bone border and the intervertebral disc. The disc was replaced by fibrous tissue and/or fibrocartilage showing moderate to severe fibrinoid necrosis and cystic degeneration. Such changes are characteristic of pseudarthrosis, which may follow either fracture or degeneration of the disc perpetuated by abnormal stress and motion. The reparative process included fibrovascular tissue proliferation from the vertebral bone marrow. Fibrovascular tissue also perforated the vertebral end-plate and intervertebral spaces resulting in massive discovertebral destruction. Pathologic observations strongly implicate mechanical trauma and pseudarthrosis as initiating and perpetuating extensive discovertebral destruction in ankylosing spondylitis.

Adult↗

PubMed1987

Scaphoid nonunion treated with the Matti-Russe technique. Long-term results.

Forty-three patients with scaphoid pseudarthrosis were surgically treated using the Matti-Russe technique. Twenty-seven patients were examined seven to 17 years after surgery (mean, 12 years). The interval between trauma and operation of the pseudarthrosis was 40 months. Before operation, all patients were unable to do any work because of pain. Fracture healing was observed in 22 cases (81%). Radiocarpal osteoarthrosis was present in 18 cases, compared with eight before operation. Radial deviation and extension was impaired, and pronation and supination was unaffected, compared with the healthy side. Twenty-four patients were satisfied with the operative result and none felt worse. All patients but one could return to work. The Matti-Russe method proved satisfactory in 24 of 43 patients available for long-term follow-up evaluation.

Adult↗

PubMed1987

New outlooks in the treatment of osteogenesis imperfecta. An unusual case successfully treated by the Ilizarov method.

The authors describe a rare case of osteogenesis imperfecta in a patient aged 29 years affected with equal deformities of the lower extremities. In the right tibia a pseudarthrosis due to a fatigue fracture had occurred at the apex of the deformity. Treatment by the traditional methods posed serious problems, both technical and from the point of view of repair of the pseudarthrosis and the trophic changes. These problems were solved by using the Ilizarov compression-extension apparatus.

Adult↗

PubMed1986

The Canadian experience with pulsed magnetic fields in the treatment of ununited tibial fractures.

A clinical survey of 56 patients was conducted at four different centers in Canada to evaluate the effect of extremely low frequency pulsed magnetic fields (PMF) on ununited fractures of the tibia. All ten patients with delayed union and 84% of the 44 patients with nonunion healed. One case with a traumatic pseudarthrosis and one with a congenital pseudarthrosis failed to respond to treatment. These results compare favorably to those reported by others using a system with different pulse characteristics. Prolonged immobilization is necessary and poses problems of rehabilitation. Nonunions with a gap between the tibial fragments and pseudarthroses are better treated with bone grafting and internal fixation prior to electrical stimulation.

Adolescent↗

PubMed1985

The management of nonunions following high tibial osteotomies.

Nonunion is an uncommon complication of high tibial osteotomy. Reported techniques of treating such a complication include resection of the pseudarthrosis and cast immobilization with risk of joint stiffness and loss of alignment. The special AO/ASIF threaded external fixator with double clamps was used to treat three patients with nonunions following high tibial osteotomy for medial compartment osteoarthritis. The pseudarthrosis was not resected in any instance. All were allowed full unrestricted joint motion postoperation. Rapid healing of the osteotomy ensued. The external fixator achieved excellent stability and rapid union while maintaining joint motion.

Adult↗

PubMed1985

Long-term results of tibiotalar arthrodesis.

One hundred and one tibiotalar arthrodeses were performed using a single surgical technique that has not been previously reported. The average follow-up was ten years (range, two to twenty-five years). The rate of pseudarthrosis was 5 per cent, four to five times less than in other recent large reports. Pseudarthrosis occurred only in patients with a sensory deficit. Secure fusion was radiographically documented in 95 per cent and the functional clinical result was good to excellent in 90 per cent. The ideal fusion position was found to be neutral or slight equinus angulation, and varus-valgus angulation equal to that of the contralateral side. More than 7 degrees of varus angulation of the heel was associated with symptomatic lateral metatarsalgia in all feet in which it occurred. Radiographic measurement documented an average 85 per cent (11-degree) increase in postoperative tarsal motion. Neither symptoms nor function correlated with the degree of tarsal hypermobility.

Adolescent↗

PubMedDate not supplied

Compression treatment of long bone pseudarthroses.

In 122 cases of non-union and delayed union, rigid fixation with Swiss compression plates without the use of casts, produced 92.6% success with the first operation. Half of the cases, especially in the well aligned fractures with hypertrophic callus, were treated without bone grafts and without resecting the pseudarthrosis. Non-resection did not adversely affect the healing time or rate. There were 9 failures or 7.4% chiefly in the difficult hypovascular atrophic bone-grafted group. Many of these cases were treated with shingling and grafts as well; 4 cases showed signs of healing but refractured secondary to trauma; 4 of 5 failures were replated and eventually healed. About 83% of the 24 infected cases healed with one compression plate operation. All of the fractures that were dry pre- and post-operatively united. In a few with drainage and poor skin coverage or cicatrix, rigid fixation with external fixators and Steinmann pins were applied. Early active exercises with delayed weight-bearing until union, gave remarkable return of function even in the difficult metaphyseal pseudarthroses. The compression method of rigid fixation is an excellent adjuvant to pseudarthrosis therapy.

Adolescent↗

PubMed1979

[Clavicular pseudarthroses in childhood].

Pseudarthrosis of the clavicula in childhood is rare. Beside the congenital forms, especially dysplasia of the skeleton, the cause of acquired pseudarthrosis is often the complete or partial lack of immobilization and poorly performed or not indicated osteosynthesis. Basically firm osteosynthesis with small DC-plates is the therapy indicated, but because of atrophic or short fragments, great defects, or if the relevant parts of the skeleton are too short, a compromise is often necessary, especially for the sake of strength. The autologeous spongiosaplastic, corticospongio bone parts, which strengthen the osteosynthesis procedure, if involved, are basic to undisturbed healing.

Child↗

PubMed1979

Reconstructive surgery in the adult for failed scoliosis fusion.

Fifty-nine adult patients were examined who had undergone previous spine surgery for scoliosis but in whom pain (78 per cent), loss of correction (68 per cent), or dyspnea (36 per cent) subsequently developed. Twenty-six patients had idiopathic scoliosis, twenty-five had paralytic scoliosis secondary to poliomyelitis, and eight had scoliosis secondary to miscellaneous etiologies. A one-stage reconstructive procedure was performed in sixteen patients and a two-stage procedure, in forty-three patients. The two-stage procedure consisted of exposure of the spine and multiple osteotomies, followed by two weeks of halofemoral traction to obtain correction. The spine fusion was then extended, using Harrington instrumentation to maintain correction. At an average follow-up of 3.3 years there was reduction of pain in 67 per cent of the patients and a solid fusion in all but two. The complication rate was high (71 per cent), the most important complications being pseudarthrosis, wound infection, urinary tract infections, loss of lumbar lordosis, and pressure sores. The mortality rate was 3.4 per cent. No patient became paraplegic at the initial surgical procedure and early recognition and treatment of pseudarthrosis will reduce the number of patients requiring this salvage operation.

Adult↗

PubMedDate not supplied

[The Paltrinieri operation in treatment of pseudarthroses of the leg].

The authors present 8 cases of pseudarthroses of the tibia secondary to surgical and orthopaedic treatments of fractures of the leg, in whom para-focal osteotomia was performed. The Paltrinieri method is a simple and efficient intervention based on the biochemical principle of re-establishing a normal tibial axis, and on exclusion of the pseudarthrosis focus from under the influence of negative mechanical factors, an intervention which leads to a revival of the capacities of consolidation of the pseudarthrosis. The very good results obtained justify the recommendation ofthis therapeutical method in the treatment of pseudarthroses, especially of the suppurated pseudarthroses of the leg.

Adult↗

PubMed1978

["Fibula-pro-tibia-fusion" (Hahn-Brandes-Graft) in treatment of bone defects of the tibia (author's transl)].

The authors use the "fibula-pro-tibia fusion" (also called Hahn-Brandes Graft, for the treating large bone defects of the tibia shaft. This method is preferred both with congenital partial tibial aplasias with acquired extensive pseudarthrosis defects of the tibia. In congenital cases, grafting of the distal end of the fibula onto the calcaneal end of the foot with careful preservation of the epiphyseal disc, should precede surgery. Large differences in leg length can be treated after fusion surgery by means of elongation osteotomies. Attention is drawn to this method in the second example of pseudarthrosis defect. Lastly the authors mention a further method for mediation of large diaphyseal tibia defects, namely the transplantation of the opposing fibula. This can lead to good results when an aggressive form of fibrous dysplasia is not present, as was the case however in the third example. In such a case the process only heals after removal of the cover of the periosteum as well.

Adult↗

PubMed1981

Surgical treatment of scoliosis following poliomyelitis. A review of one hundred and ten cases.

We reviewed the cases of 110 patients with paralytic scoliosis due to poliomyelitis who were operated on. In the lumbar region, anterior Dwyer instrumentation with posterior fusion gave excellent correction of scoliosis and pelvic obliquity. In the more rigid thoracic curves, combined anterior Dwyer instrumentation and posterior fusion gave better results than posterior fusion alone, but had more morbidity. Long c-shaped curves benefited more from a combined anterior Dwyer procedure at the apex of the curve and long posterior Harrington instrumentation. Traction was found to be of use only in rigid curves and in those larger than 80 degrees. With combined anterior and posterior fusion, there was a pseudarthrosis rate of 7 per cent in lumbar curves, none in thoracic curves, and 12.5 per cent in long c-shaped curves. The pseudarthrosis rate rose to more than 25 per cent in patients who had a posterior fusion alone.

Adolescent↗

PubMed1994

Deformity after internal fixation of fracture separation of the medial epicondyle of the humerus.

We reviewed 24 displaced fractures through the physis of the medial epicondyle of the distal humerus. One was a Salter-Harris type-II fracture-separation of the whole distal humeral epiphysis; the others involved only the medial epicondylar centre of ossification. Two cases had presented as pseudarthroses. One fracture had been treated closed in a plaster slab and 21 had had open reduction and internal fixation with sutures, Kirschner wires or Palmer nails. At 2 to 13 years later we found five types of deformity of the epicondyle: pseudarthrosis, an ulnar sulcus, a double-contoured epicondyle, hypoplasia or hyperplasia. Pseudarthrosis had developed after either no treatment, closed reduction and plaster, or open reduction and suturing. Hypoplasia followed nailing, as did a trend to varus tilting of the joint surface. One very young patient, with fracture-separation of the whole distal epiphysis treated by nailing, developed marked cubitus varus.

Adolescent↗

PubMed1993

[Ventral or dorsal spondylodesis in dens basal fracture--a new classification for choice of surgical approach].

The conservative treatment of the fracture of the densbasis (type 2 according to Anderson and D'Alonzo) bears the risk of developing a pseudarthrosis in about 30%. Therefore the anterior screw fixation according to Magerl/Böhler is general accepted. When the fracture line runs from top back to front base in this method the risk of developing a pseudarthrosis increases. With an own classification in accordance to the run of fracture line type A, B and C is differentiated. In Type A and B the anterior screw fixation is recommended. In case of type C the posterior fusion of the arches C1 and C2 is biomechanically more advisable--it results an axial compression on the fracture fissure. The usefulness of the classification is demonstrated with clinical cases.

Adult↗

PubMedDate not supplied

The intramedullary compression rod.

The Kaessmann compression device was employed in 26 patients with fractures of the long bones. In 15 fractures of the tibia, prompt healing occurred, even in fractures in the distal one-fourth of the tibia. Most of these cases were treated without external plaster support, and were permitted early ambulation, with partial weight-bearing. The technique for immobilizing these fractures involves a sliding a Kuntscher nail over a tension rod, and then fixing the clevis of the tension rod to the distal bone fragments by a transverse screw. The Kuntscher nail is fixed to the proximal bone fragment by a metal lip, and after compression is achieved, a locking sleeve fixed by a screw to the tension rod, prevents loss of compression. In 11 cases of pseudarthrosis of the tibia, the medullary canal was enlarged by passing graduated drills down the bony canal, over a guide wire. The compression rod was then inserted across the pseudarthrosis, and seventy to 80 kg/cm2 pressure was applied to the bone ends. No bone grafting procedure was performed. In all 11 cases, prompt union occurred. Postoperative management was similar to that employed in the treatment of fresh fractures. Three success fusions of the ankle also attest to the effectiveness of this immobilization. Although controversy exists regarding the role of compression in the healing of fractures, the axial compression rod does overcome distraction, compresses the bony surfaces, immobilizing them securely to produce union with an economy of callus.

Ankle Joint↗

PubMed1993

Intertransverse process lumbar arthrodesis with allogeneic fresh-frozen bone graft.

Nine patients were treated with ten intertransverse process lumbar spine anthrodeses using fresh-frozen crushed corticocancellous allogeneic bone as graft material. No instrumentation was used. The clinical and roentgenographic follow-up period ranged from one to three years. Seven procedures showed successful arthrodesis and three demonstrated pseudarthroses. Increased age and systemic disease were associated with an increased risk of pseudarthrosis. Persistent back pain was associated with pseudarthrosis. Compared with 58 patients treated with intertransverse process lumbar fusion with autogeneic iliac bone as graft material, the overall fusion rate is inferior: 70% versus 92%, respectively.

Adolescent↗

PubMed1997

[Treatment of long tubular bone pseudoarthrosis with revascularized cortical layer of radius].

The method of osteogenesis without resection of the false joint was employed in the treatment of long tubular bone pseudarthrosis. The authors used a free revascularized radial flap, including the corticoperiosteal layer of the radius as a source of osteogenesis. A thin corticoperiosteal graft was taken from the distal third of the radius with or without a skin flap, if necessary. The graft was placed into the slotted bed of the false joint and fixed by two screws. Final fixation was made by using an Ilizarov apparatus or a metal plate. The authors used this procedure in the treatment of 12 patients with long tubular bone pseudarthrosis who had undergone at two operations on the false joint or fracture. Eight patients suffered from chronic osteomyelitis. Eleven patients completely recovered at postoperative month 12. Radiographic and scintigraphic investigations showed signs of bed-graft adhesion at month 3 after surgery and those of false joint ossification at month 6 postoperatively.

Adult↗

PubMed1983

Morphologic aspects of bone healing after third-degree open fractures. An experimental study.

The morphologic aspects of undisturbed and disturbed bone healing following third-degree open fractures is demonstrated by means of experimental investigations using animals. As an experimental model we used a canine thigh fractured by a shot. The data was obtained as part of bioballistic investigations of the effect of highvelocity bullets in living tubular bones. The shot fracture was immobilized by external fixation. Progressive radiological controls, as well as microangiographic, microradiographic and histological findings are used to show bone healing. Bone healing following shot fractures follows the basic pattern of secondary bone healing, which is manifested in an X-ray by the formation of periosteal callus. The periosteal callus tissue has its own vascular system and receives blood from the extraosseous vessels of the adjacent soft tissue surrounding it. It not only fulfills the function of the biological stabilizer of the fragments, but also contributes decisively to their revascularization through transcortical anastomosis. The morphologic appearance and the causes for the disruption of bone healing are demonstrated using individual examples. Predominant are insufficient stability and above all circulatory disturbances. In the case of fractures with considerable soft-tissue damage, not only is the intramedullary vascular system destroyed, but the blood supply to the periosteal vessels is also disrupted. The resulting delay to or absence of callus formation leads on the one hand to insufficient biological stabilization, and on the other hand to an impairment of fragment revascularization. The morphologic appearance is dominated by the fragment necroses and related complications, such as pseudarthrosis induced by bone necrosis and infected pseudarthrosis.

Animals↗