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Results for “PSEUDARTHROSIS”

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PubMed1997

[Long-term results of 9 cases of elongation of the ulna in treatment of Kienböck's disease].

The treatment of Kienböck's disease is currently controversial. Ulnar shortness is usually considered to be the main etiological factor. This observation is the basis for distal radio-ulnar joint levelling procedures, which means the radial shortening osteotomy and ulnar lengthening osteotomy. Several authors have reported their experience on the topic, but there are very few studies with sufficient follow-up to evaluate the value of the operative procedure on the carpus. We report a 9 patient review series following an ulnar lengthening procedure for Kienböck's disease. The average follow-up was 24 years (range: 12 to 21 years). There were 7 men and 2 women and the average age was 30 years at the time of the operation. The dominant side was affected 6 times out of 9.6 heavy workers and 3 light workers are reported. Four out of 9 patients had a history of trauma. The surgical procedure was a stair-step distal diaphyseal ulnar lengthening with distraction and osteosynthesis with a plate, without bone graft. The selected patients underwent a clinical examination of wrist pain, mobility and strength in comparison with the non-operated side. All patients under went a standard radiographical examination in neutral position. The analysis of the series shows that ulnar lengthening was successful for all patients especially on the strength and pain level, whereas mobility deteriorated. Without being able to reconstitute the normal morphology of the lunate bone, the procedure was able to stop the long-term natural course of the disease leading to carpus collapse and arthrosis without radio-carpal disturbance. Excessively long consolidation times and a very high pseudarthrosis rate are reported. Ulnar shortness does not seem to be an etiological factor. The natural history of the disease is perhaps not as bad as previously thought. The impact of the procedure on the distal radio-ulnar joint and the ulnar impaction syndrome in excessive lengthening are serious issues which need to be resolved. The procedure is preferably indicated in young patients, at the beginning of the disease, with a negative distal radio-ulnar variance. The Linscheid operative technique is recommended.

Adult↗

PubMed2001

[Ulnar nerve compression and pseudoarthrosis of the medial metacarpal bases].

A case of compression of the deep branch of the ulnar nerve associated with pseudarthrosis of the base of the fifth metacarpal and the upper shaft of the fourth metacarpal is reported. The delayed procedure consisted in volar decompression of the ulnar nerve by dividing the pisi-hamate ligament and plating and grafting of both fractures. The patient achieved marked improvement four weeks post-operatively and had complete functional recovery at follow-up of 16 years after injury without narrowing of the hamato-metacarpal joint despite synostosis of the bases of the medial metacarpals.

Adult↗

PubMedDate not supplied

Failure of posterior titanium atlantoaxial cable fixation.

BACKGROUND CONTEXT: The operative treatment of rotatory atlantoaxial instability remains controversial. The use of cable fixation has largely replaced the use of wire for interlaminar fixation. Although cable fixation offers biomechanical advantages over wire fixation, it is still at risk of fatigue failure. The authors were unable to locate any published reports of fatigue failure of titanium cables in the fixation of atlantoaxial instability. PURPOSE: The purpose of this case study is to describe an unusual case of fatigue failure of a titanium cable used to aid in atlantoaxial fusion for the treatment of rotatory atlantoaxial instability. STUDY DESIGN: Case study. METHODS: We reviewed the medical records and X-rays of a patient with rotatory atlantoaxial instability treated with posterior C1-C2 fusion and atlantoaxial fixation with a titanium multistranded cable, who developed fracture of the cable and migration of the cable into the spinal canal. RESULTS: The patient was revised with removal of the broken cable, repair of the pseudarthrosis and fixation with atlantoaxial screws. CONCLUSION: Interlaminar fixation with cables or wires is at risk for failure with potential migration of the wire or cable into the spinal canal. The authors found that failure of the cables or wire can be salvaged with application of transarticular screws.

Adult↗

PubMed1975

[Dorsal stabilization in dislocated fractures of C-1 and C-2 vertebrae with Palacos and wiring].

During 1 year 6 patients with dislocated fractures of C-1 and C-2 vertebrae (fractures of the odontoid process) and 1 patient with a pseudarthrosis of the odontoid process have been treated. 6 patients have been treated surgically by internal fixation of the arch of C-1 and C-2 spinous process by wiring and plastic material (Palacos). No complications occurred. The advantage of the method was early mobilization of the patients and reduction of hospitalization. Clinical and radiographic follow-up studies showed stable fusion on Flexion-extension X-rays and boney union of the fracture of the odontoid process.

Adolescent↗

PubMed1976

[Congenital bowing of the tibia in neurofibromatosis von Recklinghausen (author's transl)].

There is a close, but not constant, relationship between congenital bowing of the tibia or infantile pseudo-arthrosis of the tibia and von Recklinghausen's neurofibromatosis. In about 40% it is possible to confirm the diagnosis by examining relatives, but the radiological findings and the course of the disease, as well as by histological examination. Anterior bowing with dysplastic-sclerotic bone changes results in the "high risk tibia". This may lead to a pathological fracture. Treatment depends on the clinical findings and radiological changes. It should be aimed at preventing pathological fractures and pseudarthrosis.

Adolescent↗

PubMed1999

[Comparison of various evaluation measures for assessment of treatment success after scaphoid injuries].

Different evaluation scores have been developed in order to assess treatment outcome of carpal injuries. The available scores are not comparable and differ in type and number of parameters. This is a retrospective study of 100 patients who presented with a fracture or a pseudarthrosis of the scaphoid from 1983 to 1997. The Cooney and the Meine scores were compared with our own score. While the Cooney score and the newly developed score show an equal distribution of results in all categories, the score of Meine led to an overall better outcome assessment. The comparative evaluation of the different scores shows that the combination of only a few well defined parameters is sufficient for assessing the treatment outcome of carpal injuries.

Activities of Daily Living↗

PubMed2001

[Incidence of complications of the screw osteosynthesis of odontoid process fractures].

In this retrospective clinical study the incidence of complications in 58 consecutive, with anterior screw fixation stabilized patients after fractures of the odontoid process is evaluated. In 51 patients the fracture has been defined as type II according to Anderson, in 6 patients an oblique type II fracture was present and one patient showed a cephalad type III fracture. Preoperatively, in only 19 % of the patients (n = 11) no dislocation of the dens occurred. 32 patients were treated with single screw osteosynthesis, in 26 patients two screws were implanted. Significant complications with clinical relevance were registered in 14 patients (24 %), in 10 cases (17 %) an operative reintervention was required. Intraoperatively, in one patient a rupture of the carotid artery while winding around the motor drill occurred and in another case a complete malplacement of the screw posteriorly to the odontoid process was observed. A clearly excentric positioning of the implant was evaluated in 5 patients with a consecutive high rate of implant migration (n = 3). Two patients died perioperatively not related to the cervical injury. Postoperatively, one patient with a wound infection due to an iatrogenic perforation of the esophagus required reoperation as well as 4 patients with instability because of implant migration. Patients beyond the age of 65 years (n = 3) were significantly overrepresented in that group. In one case, the secondary intervention was caused by a pseudarthrosis of the dens axis. Complications without any relevance to the clinical and functional long term result were fusions in malposition of the odontoid process in 14 patients (24 %) and 10 (17 %) marginal screw perforations laterally. Differences in the use of one or two screws have not been observed in this study, although the investigations showed a tendency between marginal lateral screw perforations and double screw osteosynthesis and an increasing number of complications in the geriatric cohort.

Adolescent↗

PubMed2003

Telescoping vascularized fibular graft: a new method.

The authors describe a case of congenital pseudarthrosis of the tibia treated with a telescoping vascularized fibular graft. The advantages of this new method are that bone union and leg-length discrepancy may be corrected simultaneously.

Bone Transplantation↗

PubMedDate not supplied

[Posteromedial bowing of the lower leg and neuroblastoma with possible neurofibromatosis type I: a case report and literature review].

BACKGROUND: The posteromedial bowing of the tibia is a rare condition that is not yet known to be related to neurofibromatosis. The case of a three month-old boy with the tentative diagnosis of neurofibromatosis is described. He developed paraplegia due to an abdominal neuroblastoma at the age of 9 months. This led us to a review of the literature. METHOD: 122 cases of posteromedial bowing of the tibia in 20 publications of the years 1949 - 2000 were analysed under special respect to gender, side of affection, shortening of the lower leg, treatment and possible cause. RESULTS: The posteromedial bowing of the lower leg seems to affect more boys as well as the left side. As far as described in all but one case it was the first delivery. Regularly, a limb shortening and pes calcaneovalgus is to be found. 99 children were treated conservatively, 21 got an operation of the affected side. In 19 performed osteotomies no pseudarthrosis occurred. One case of a fracture due to an adequate trauma without healing problems is described.

Abdominal Neoplasms↗

PubMed1999

Use of a reversed-flow vascularized pedicle fibular graft for treatment of nonunion of the tibia.

Ten patients with nonunion of the lower tibia were treated with a vascularized ipsilateral fibular graft, that was transferred distally and based on retrograde peroneal vessel flow. Eight patients were treated for congenital pseudarthrosis of the tibia; one had a nonunion subsequent to infection, and another patient had bone and skin loss due to infection. A posterior approach was used to expose the tibia and to harvest the fibula. Bone union and full weight-bearing were achieved in all cases by 9 months. The patients were followed-up for a mean of 1.8 years (range: 1.5 to 3 years).

Adult↗

PubMed1993

Fracture through united vascularized bone grafts.

The secondary fracture rate in 53 patients undergoing vascularized bone transfer for long-bone reconstruction, with a follow-up period of at least 2 years, is evaluated in this report. Twelve fractures occurred in 10 patients. Characteristics of the fractures were: (1) most occurred at the tibia recipient site; (2) most occurred through the transferred vascularized bone segment, rather than at its junctions; and (3) all fractures occurred within 1 year following bone union. When the fracture occurred in adults, union was relatively easily obtained by application of simple external fixation; on the other hand, union was difficult to obtain in patients with congenital pseudarthrosis of the tibia.

Adult↗

PubMedDate not supplied

[Ventral compression spondylodesis using internal fixator instrumentation--a biomechanical study].

Pseudarthrosis is said to be a main complication in anterior interbody fusion. It is usually the result of an insufficient mechanical stability which hinders bony incorporation of intervertebral bone grafts. In order to improve stability dorsal transpedicular instrumentation should be carried out to achieve interfragmentary compression between bone block and adjacent vertebral endplate. Using human lumbar spine cadavers and a capacitive measuring mat an experimental study was completed to find out in which way an internal fixator has to be used to achieve this goal. The collected data showed that simple compression of the fixator by reducing the distance between the Schanz-screws did not produce sufficient interfragmentary compression. Preloading the fixator in kyphosis and compression in a second step improved the results significantly. Using this technique a compressive interbody fusion can be attained.

Adolescent↗

PubMedDate not supplied

[Triple osteotomy of the pelvis in dysplastic hip joints in children and adults].

We report on a post operative radiological and clinical follow-up (3-6.4 years) of 80 triple-osteotomies (29 operations according to the technique of Carlioz and 51 according to Tönnis). This study includes 32 osteotomies in children and 48 in adults. In 82% of the cases of low dysplastic hip joints and in 88% of the cases in severe dysplastic hip joints, the results came up to the expectations of the patients. The acetabular inclination angle and the acetabular angle improved about 10 degrees and the center edge angle about 25 degrees. In cases of neurological diseases, the radiological results of the hips were less satisfactory. The results is negatively influenced by pseudarthrosis and stress fractures in the ischium. These complications occur to a lower degree after Tönnis-osteotomy. From the age of 7, the triple-osteotomy represents an useful alternative to the operative correction of the hip joint dysplasia. The operation can be carried out in cases of congruity of head and acetabulum. Under certain circumstances, a transposition operation is additionally necessary, it is only indicated with a coxa valga. The triple-osteotomy can positively influence the biomechanical situation of the hip joint by means of an improved head roofing, by an ameliorated adjoining of the area of force reception to the pressure resultant and by medialisation of the acetabulum.

Adolescent↗

PubMedDate not supplied

[Use of autocompression plates in the treatment of pseudarthroses].

Report about the results of surgical treatment of 115 pseudarthroses of the long shaft bones treated by means of autocompression plates (ACP) in about 2/3 of the cases an additional autogenous bone plasty was performed. A follow-up examination was possible in 113 cases (98.25%). At all a solid consolidation could be achieved in 93.0%, even in difficult primary situations, including defect pseudarthroses and also infections. In 86.1% the healing occurred after the first surgery, in the remaining cases revisions were needed. Complications were very rare. In 3.5% arthrodesis or joint replacement of the involved joint was performed. Finally only 1.75% persisted in pseudarthrosis.

Adult↗

PubMedDate not supplied

[Ventral intercorporeal traction spondylodesis of the lumbar spine].

At 35.7% the average rate of pseudarthrosis following ventral spondylodesis of a segment of the lumbar spine is very high. The inadequate degree of primary stability in the segment to be ankylosed is seen as the fundamental reason for this. In the present paper an implant made of a nickel-titanium alloy ("Memory Alloy") is described, which is inserted intercorporeally and immobilizes the moving segment by traction. Experiments in sheep have confirmed that the anchorages of the implant are stable; it was also established that bony fusion occurred both around the implant as well as through it. Observations thus far in 10 patients treated by this method have shown that the implant remains stably anchored, and in some cases clear signs of bone bridge formation were demonstrable on radiographs after only a short time. If the primary stability provided by the Memory implant continues to be thus confirmed, postoperative hospitalization will in future be limited to a few days.

Animals↗

PubMedDate not supplied

[Stabilization of the lumbosacral segment by distracting posterolateral spondylodesis using the Zielke divided sacral strut. Analysis of 400 cases based on indications, results and cause of errors].

Out of 400 patients who underwent posterolateral or purely dorsal spondylodesis of the lumbosacral joint with a divided sacral strut or sacral knee using distracting Harrington struts, a total of 68.5% were free of complaints--100% in cases of fractures and destruction, spondylarthroses and osteochrondroses, 73% in cases of spondylolyses with and without spondylolistheses, and only 49% among the so-called "failed-back" patients who had already undergone one or more previous operations. Where results were poor, particularly in the group of failed-back patients, when surgical error, pseudarthroses, or inadequacies of instruments were ruled out, it could be assumed in approximately 80% of the cases that these patients simultaneously had a pension claim under review or had attempted to institute proceedings at a social insurance tribunal. In such cases the goal of treatment desired by the surgeon, i.e., pain-free stability, cannot be the aim of the patients. Freedom from pain means ability to work, and loss of the pension or the pension litigation. It is almost endemic among these patients to put the blame on the same exogenous mechanisms, as far as both time and cause are concerned, in order to obtain certification of their inability to work. The suspicion that they use the operation to prove the severity of their disability is in many cases justified. The high incidence of psychosocial problems is at least a partial explanation of why the measures we took in our efforts to improve the results of surgery failed. We changed the position of the patient, extended the duration of hospitalization, revised our implantation method, verified plasters and braces. To no avail. Essentially, the result of surgery was influenced by four factors: the number of previous operations, drug and alcohol abuse, pseudarthrosis, and simultaneous pension claims. In 1983 and 1984 the number of patients without pain soared. Basically, this is probably due to the fact that in the light of the results of this investigation, more stringent criteria were applied with regard to the selection of patients. If the patient has a claim against a social insurance institution, a private insurer, or physicians who have treated him/her previously (!!!) we refuse to operate. It is unlikely that these patients will be pain-free before the proceedings in question are terminated. This much we have learned from this analysis.(ABSTRACT TRUNCATED AT 400 WORDS)

Follow-Up Studies↗

PubMedDate not supplied

[Surgical treatment of unstable, therapy-resistant and painful lumbosacral joints by distracting decompressive posterolateral spondylodesis over the divided sacral bar according to Zielke's method (author's transl)].

Here the procedure of the distracting decompressive fusion over the divided sacral bar which Zielke developed 8 years ago is being described. This procedure was applied in over 150 cases. In a follow-up only one pseudarthrosis was found in the area of L5/S1. 70% of the previously pensioned patients could at least be partially rehabilitated. 32 patients were asked of their opinion with a questionnaire. Only 2 patients (6%) assessed the operation results with "bad". Indication is in all instabilities of the lumbosacral joint. The problem of the multi-operated back can be largely solved through the possibilities of this procedure.

Adolescent↗

PubMed1981

[Combined plastic bridging of a post-traumatic osseous defect of the tibia in the sense of compound osteosynthesis in elderly patients (author's transl)].

The article presents a woman (now 82 years of age) in whom adjustment osteotomy had been performed in order to cope with her proximal fracture of the tibia which had healed in varus position after conservative therapy. After absorption of the bone wedge and loosening of the osteosynthesis material, the defect was filled with bone cement with embedded screws and plates. Three years later, the patient returned for treatment with completely loosened Palacos seal which had perforated distally through the skin and rather broadly. Besides pseudarthrosis, there was also a marked arthrosis of the knee joint. The patient was re-operated, bridging the defect by means of Fracto nets and a bolted Placos seal into which a Sheehan's knee was inserted.

Aged↗