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PubMed2004

[Reosteosynthesis in dens pseudarthrosis. Case report and review of the literature].

According to general recommendations, unstable nonunions of the odontoid are treated by posterior fusion of the segments C1/C2 and transarticular screwosteosynthesis. The aim of the surgical procedure is to obtain secure reduction stabilization, and fusion of the nonunion. We present a case of secondary atlanto-axial instability treatment following of an odontoid nonunion. In this situation stability of C1/C2 was achieved by atlanto-axial fusion by transarticular screw fixation. The ventral parts of the broken implants were left in place. Diagnosis, treatment and complications of pseudarthrosis of the dens axis are discussed in the context of this case and of literature.

Bone Screws↗
PubMed1998

[Elbow para-articular pseudarthrosis. Etiology and treatment].

Non-unions in the proximity of the elbow are very rare and in most cases caused by mistakes in initial treatment. Reconstruction after pseudarthrosis of the elbow continues to pose a challenge for any surgeon. The aim of our study was to analyze the initial mistakes and to underline the most important aspects of reconstructive surgery. In a retrospective study over a defined period of 10 years (1/1985 to 12/1994) we were able to treat altogether 27 non-unions in the proximity of the elbow. These patients were transferred to our hospital at an average of 44 weeks after initial therapy elsewhere. The main symptoms were in 17 cases pain and in all other patients functional deficit. Reconstructive surgery was performed an average 54 weeks after the primary injury. In 24 out of 27 cases a re-osteosynthesis, in 12 an arthrolysis, in 7 a neurolysis and in 2 cases an arthroplasty was needed. The patient could return to work an average 18 weeks after the operation and 53 weeks after injury. The initial complaints were reduced in 24 of 27 cases, with a significant improvement in the ROM and functional outcome according to the Mayo Elbow Performance Index.

Adolescent↗
PubMed2001

[Surgical treatment of femoral neck pseudarthrosis associated with delayed union of ipsilateral femoral shaft fracture].

A femoral neck fracture combined with an ipsilateral shaft fracture is often primarily not diagnosed. The later treatment is technically more difficult, because in the choice of operative technique for the shaft fracture the neck fracture it was not considered. In this case report the treatment of the shaft fracture with a reamed nail, and the secondary stabilisation of the femoral neck fracture with screws resulted in a pseudarthrosis of the femoral neck with an unfavourable inclination of the fracture plane. Both fractures healed without complications after changing the nail against a bridging plate and an intertrochanteric osteotomy with correction in two planes.

Adult↗
PubMed2000

[The treatment of congenital tibial pseudarthrosis].

Congenital tibial pseudarthrosis (CTP) remains one of the most challenging problems in paediatric orthopaedic surgery. With the abandonment of older grafting techniques in favor of vascularized fibular transplants or the Ilizarov method the final outcome has improved and made the prognosis for patients less cumbersome. Using the latter technique in 10 patients, a success rate of 90 % could be reached. Nevertheless, although solid healing occurs in most of the patients nowadays, this is often at the cost of multiple operations before a definite well united, equalized and normally aligned limb can be obtained.

Child, Preschool↗
PubMed1996

[Comparison between various treatment methods in scaphoid pseudarthrosis].

In this study we compare the results of various methods of treatment in 159 patients who were operated on between 1980 and 1990 for scaphoid pseudarthrosis at the Budapest Central Institute for Traumatology. Rated subjectively, 84% of the results of the Russe-I plasty were regarded as good, as were 75% of the spongiosaplasty, 88% of the Ender plate synthesis, and 75% of the AO navicular screw. Of the palliative methods retaining movement, denervation with styloidectomy yielded good results. Silicon prosthesis and proximal pole resection only led to temporary improvement. In patients with severe radiocarpal arthrosis who do heavy work, even today radiocarpal stiffening is regarded as the procedure of choice. In our experience, the best functional results can be expected when immobilization is as short as possible and fixation as stable as possible - which corresponds to Ender plate synthesis according to our results.

Adolescent↗
PubMed2000

[Congenital pseudarthrosis of the tibia].

Congenital pseudarthrosis of the tibia (CPT) is one of the most challenging conditions in paediatric orthopaedics. The history of CPT treatment is characterised by repeatedly ineffective surgical interventions with the inevitable outcome of severe disability. Most procedures failed to account for the complexity of the problem. The past two decades have witnessed more experience having been gained with the Ilizarov technique. This method provides a comprehensive approach to all aspects of CPT problem, allowing the surgeon to simultaneously address the problems of union as well as those of deformity, length discrepancy joint function, ankle valgus and weight bearing. It appears that the goal to achieve stable fusion before the child begins school is attainable. In the pre-pseudoarthrotic stage, bracing should be preferred to surgery until the patient is in an older age group. This study reports on the results of 19 patients: 15 have finished treatment, and 14 of them with a stable fusion at follow-up. The results were highly encouraging in reaching the ultimate goal of avoiding amputation and achieving a well-functioning limb.

Adolescent↗
PubMed1996

Congenital pseudarthrosis of the tibia.

The present concepts of the aetiology, prevention and treatment of congenital pseudarthrosis of the tibia are discussed. The satisfactory results of Ilizarov's method and vascularised fibular grafting make these methods optimal choices for treatment. When they are not available, a bone graft with intramedullary fixation is a valuable alternative.

Amputation, Surgical↗
PubMed2001

Congenital pseudarthrosis of the ulna and radius in two cases of neurofibromatosis type 1.

Two children with neurofibromatosis type 1 who presented at birth with congenital pseudarthrosis of the ulna and radius are described. The patients were treated with broad resections. As a consequence, the forearms were reduced in length. The osteotomies were stabilized in one patient first with endomedullary nailing and then with a free vascularized fibular graft. In the second patient the osteotomy was stabilized by external fixation. Using these techniques, rapid and excellent healing and normal function were achieved. In contrast to the lower extremity, reduction of the length of the forearm can be accepted to a certain extent. If necessary, an extension osteotomy can be performed at a later date.

Bone Transplantation↗
PubMed1975

Visits abroad: the treatment of pseudarthrosis in the Soviet Union.

Three British surgeons on a visit to Russia were impressed with the Russian technique known as "compression distraction" used mainly in the treatment of infected pseudarthrosis of the tibia. Multiple thick Kirschner wires drilled through the tibia at a distance from the lesion were fixed in stirrups attached to steel rods and turnbuckles. By adjustment of the apparatus deformity was corrected at the time of application; shortening was overcome by gradual turnbuckling. The equipment was also used for leg lengthening and for complicated recent injuries.

Adolescent↗
PubMed1982

Treatment of pseudarthrosis of the clavicle.

Twelve patients were operated on between 1974 and 1979 for painful pseudarthrosis of the clavicle. The time from the injury to the operation ranged from 4 months to 12 years. We used an AO plate fixation and cancellous bone graft. The patients were able to return to work within 2 months on average. The AO plate was removed 8 to 12 months after the operation. At the 1 year follow-up all the pseudarthroses had consolidated and the patients were satisfied with the result of the treatment.

Adult↗
PubMed1982

The 99Tcm-Sn-polyphosphate scintimetric time course of human tibial fractures with delayed union or pseudarthrosis.

In 17 fractures of the human tibia, showing delayed union or the development of pseudarthrosis, the amount of callus formed was assessed monthly by scintimetry following intravenous administration of 99Tcm-Sn-polyphosphate. The mean scintimetric time course of the group of fractures with the atrophic type of delayed union was statistically significantly lower between the fourth and fourteenth week than that of fractures with uncomplicated healing. Nearly two-thirds of the fractures showed scintimetric ratios below the lower normal confidence limit (2 s.d.). The mean scintimetric time course of the fractures with the hypertrophic type of delayed union showed a normal scintimetric time course up to the eighth week, but from the tenth week a statistically significantly higher scintimetric ratio than the fractures with uncomplicated healing was found. The scintimetric ratio after the fourteenth week was below 2.5 for fractures with the atrophic type of delayed union, and above 2.5 for fractures with the hypertrophic type. The scintimetric time course of fractures which developed pseudarthroses was not different from those showing delayed union. The scintimetric method allows early detection of a pathological course of fracture healing. It supplies information about the functional state of the healing process and serves as an indicator of the correct treatment.

Adolescent↗
PubMed1977

Preventive treatment of congenital pseudarthrosis of tibia.

If an osteotomy is carried out in a child with congenital angulation of the tibia with segmental sclerosis, a pseudarthrosis develops in many cases. This should be prevented by a bone-graft operation along the concave side of the tibia. The results described illustrate this contention.

Bone Transplantation↗
PubMed1994

Congenital pseudarthrosis of the ulna.

Congenital ulnar pseudarthrosis is a very rare condition. Two cases are reported in addition to 36 already reported in the English literature. One of the cases reported had a "one-bone forearm" procedure done, with a satisfactory result after 6 years. The second case had a free vascularized fibula graft procedure with restoration of the bony alignment and union after 8 months of follow-up.

Bone Transplantation↗
PubMed1989

Pseudarthrosis of the radius treated by free vascularised bone graft.

We report a case of pseudarthrosis of the radius successfully treated by free vascularised bone grafting. After a comprehensive review of the literature, we recommend this as the treatment of choice in this condition. We also report the use of callus distraction of an incorporated vascularised bone graft to achieve bone lengthening.

Bone Lengthening↗
PubMed2005

Vascular changes in the periosteum of congenital pseudarthrosis of the tibia.

The etiology and the pathogenesis of congenital pseudarthrosis of the tibia (CPT) are still unknown. The affected tibia exhibits insufficient mechanical strength and osteogenetic capability. CPT is frequently associated with neurofibromatosis type 1 (NF1; von Recklinghausen's disease); however, both diseases have not yet been linked pathogenetically. This study presents the pathomorphologic findings of CPT under special consideration of NF1. Therefore, samples from patients operated on for CPT (n = 4) with (n = 3) and without (n = 1) neurofibromatosis were investigated by light microscopy, immunohistochemistry, and electron microscopy. The most striking finding in all patients was thickened periosteum with accumulation of nerval cells surrounding small arteries, causing subtotal or complete obliteration. In conclusion, impaired vascularization can result in decreased osteogenic capabilities. The similarity of ultrastructural findings in the abnormal periosteum and in skin neurofibromas of neurofibromatosis patients may indicate a pathogenetic association of both diseases.

Adolescent↗
PubMed1978

The treatment of non-union and pseudarthrosis of the long bones with thick nails.

This paper is based on Küntscher's method of operative treatment of the long bones(Küntscher, 1962) and is a review of 197 cases of non-union and pseudarthrosis of long bones fixed internally with thick metal nails after preliminary reaming of the medullary canal. New reamers and a new nail have been designed and the results are satisfactory. The rigid fixation of the fragments allowed early movement of the limb and so avoided the complications of prolonged immobilization. Anabolic steroids were administered as a routine to this group of patients. Weight bearing and full function of the limb were regained within 3-5 months of the operation. Poor results occurred in 6 cases (3.2 per cent) due to exacerbation of chronic osteomyelitis.

Adult↗
PubMed2005

[Congenital pseudarthrosis of the forearm in a neurofibromatosis patient: case report and review of the literature].

We report a case of congenital pseudarthrosis of the forearm associated with neurofibromatosis type 1 which was treated by free vascularized periosteal flap transplant and repeated bone grafting. The young female patient recovered good hand and forearm function. A review of the literature revealed the rare occurrence of this disease (approximately 100 cases reported to date), which probably explains the wide variety of surgical proposals.

Abnormalities, Multiple↗