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PubMed1975

Congenital pseudarthrosis of the tibia.

Congenital pseudarthrosis of the tibia is a rare and difficult problem. The cause is unknown, the treatment is nonstandardized, and the results are generally poor. One or two good attempts at union should be made, followed by amputation if union is not obtained or if deformity is worse than that produced by a prosthesis. Electrical stimulation of bone healing is not yet technically advanced enough for use in stimulating fractures to heal in humans, but it has been proven to promote healing in animals and holds considerable promise for the future.

Amputation, Surgical↗
PubMed1985

Stereophotogrammetry of the lumbar spine. A technique for the detection of pseudarthrosis.

A computer-assisted photogrammetric method for the detection of pseudarthrosis following spinal fusion is described. This radiologic method is quantitative and noninvasive and requires a minimum of clinician time. Results of tests with a phantom specimen are presented. Preliminary indications are that the method may prove to be a useful adjunct to the clinician in monitoring the postoperative course of patients requiring fusion procedures.

Lumbar Vertebrae↗
PubMed1993

A histologic study of lumbar pseudarthrosis.

Biopsy specimens were obtained from 35 consecutive patients undergoing pseudarthrosis repair after failed posterior spinal fusions. Biopsy specimens were obtained when possible from the fusion mass, from areas of motion, and from the lumbar facet remnant where identifiable. Tissue found between adjacent bony segments was noted to contain predominantly fibrous tissue often accompanied by signs of local fibrocartilaginous metaplasia. In addition, small fragments of impacted bone, sometimes seen to be undergoing active resorption, also were noted frequently in these areas. The bone adjacent to the areas of motion was sclerotic and poorly organized, containing a mixture of woven and lamellar bone. Interestingly, multiple microtrabecular fracture with appositional new bone formation was a frequently seen feature. All facet joint biopsies were noted to have evidence of degenerative disease. Both cartilage fissuring and significant chondrocyte cloning were noted. Subchondral bony sclerosis was also a consistent feature.

Biopsy↗
PubMed1993

The outcome of pseudarthrosis after cervical anterior fusion.

This article reviews the outcome of 23 consecutive patients who developed pseudarthrosis after anterior cervical fusion surgery. Sixteen of the 23 patients failed to achieve significant relief of their symptoms (69.6%). These 16 had a second fusion procedure. Thirteen of this same 16 obtained a fusion, and 9 of these (69.2%) converted to an excellent or good result. These findings support the thesis that solid arthrodesis is important to a successful outcome of anterior cervical fusion procedures.

Adult↗
PubMed1994

Pseudarthrosis rate after allograft posterior lumbar interbody fusion with pedicle screw and plate fixation.

STUDY DESIGN: Twenty-five of 26 consecutive patients were studied after posterior lumbar interbody fusion using ethylene oxide-sterilized allograft bone for posterior lumbar interbody fusion and autologous bone for posterolateral fusion with posterior fixation using pedicle screws and variable screw placement plates. OBJECTIVES: Patients were studied at 1 year to determine rate of complications, pseudarthrosis, and re-operations. METHODS: Clinical success was determined by combined five-point analog pain and function scales. Fusion success was determined by plain radiographs. RESULTS: Complications occurred in four of 25 patients (16%). Re-operations were done in nine of 25 patients (36%) with seven re-operations (28%) to treat frank failures of the donor bone. Although some patients subsequently improved with repeat surgery, the result of the donor bone posterior lumbar interbody fusion was excellent in nine patients, good in four, fair in eight, and poor in four. Posterior lumbar interbody fusion success was achieved in 14 of 25 patients (56%). Clinical success was achieved in 15 of 25 patients (60%). CONCLUSIONS: Although the mechanical principles of posterior lumbar interbody fusion were affirmed, the adequacy of ethylene oxide-sterilized allograft bone in meeting the mechanical and biologic needs of posterior lumbar interbody fusion was questioned.

Adult↗
PubMed2002

Does instrumented anterior scoliosis surgery lead to kyphosis, pseudarthrosis, or inadequate correction in adults?

STUDY DESIGN: Retrospective review of cases in which a single solid rod was used for the anterior correction of thoracolumbar and lumbar idiopathic scoliosis in adults. OBJECTIVES: To evaluate the efficacy and outcomes in these patients. SUMMARY OF BACKGROUND DATA: Anterior spinal fusion with instrumentation has been found to be kyphogenic in the treatment of scoliosis. Recent reports have shown an extremely high rate of pseudarthrosis and implant failure even in adolescents who have undergone anterior spinal fusion with a single flexible or rigid rod. METHODS: Fifteen consecutive adult patients with (average age, 37.5 years) had undergone anterior spinal fusion with a rigid rod were included in this study. One was lost to follow-up, leaving 14 patients with a complete radiographic follow-up of 44 months and clinical follow-up of 61 months. Patients were sent the Modified Scoliosis Research Society (SRS) Outcomes Instrument, charts were reviewed, and preoperative, postoperative, and final follow-up films of the entire spine were evaluated by independent reviewers uninvolved in the care of the patients. RESULTS: The average preoperative major curve was 50 degrees, which improved to 16 degrees at follow-up (a 66% correction). The average correction of the upper compensatory curve and lower fractional curve were 40% and 61%, respectively. The thoracolumbar sagittal plane alignment was maintained or improved in all patients (i.e., this surgery did not induce kyphosis in any patient). On average 0.9 levels were "saved" compared with levels chosen by the authors for posterior surgery. All patients achieved a solid fusion. Follow-up Modified SRS questionnaires revealed a satisfaction score 4.5 out of a possible score of 5, a pain score of 4.1 out of 5, a self-image score of 4.1 out of 5, a function score of 4.1 out of 5, and a mental health score of 4.0 out of 5, with an overall score of 82%. All patients but one were satisfied or extremely satisfied with the results of surgery. There was no incidence of implant breakage. CONCLUSIONS: The results of anterior spinal fusion using a single solid rod in adults with idiopathic scoliosis in this series are excellent, with 100% fusion rate, no development of kyphosis, and no incidence of hardware failure.

Adult↗
PubMed2004

Telescoping vascularized fibular graft: a new method for treatment of congenital tibial pseudarthrosis with severe shortening.

Vascularized fibular grafts have proved reliable in the treatment of congenital pseudarthrosis of the tibia with a high success rate. However, severe shortening cannot be primarily corrected by this technique and requires a second-stage lengthening procedure. Ilizarov's method allows correction of shortening and axial malalignment together with the non-union. However, in the dysplastic type with severe shortening, corticotomy of the affected bone may result in delayed consolidation or recurrence of disease. In addition, the large distraction distance (equal to the amount of shortening plus the resulting defect after excision of the pseudorthrosis site) requires prolonged frame application, which may not be tolerated by the patient. We present a new technique combining vascularized fibular graft and Ilizarov distraction that allows simultaneous correction of shortening while treating the non-union in a single-stage operation. This method avoids corticotomy in the congenitally affected bone and markedly shortens the time of frame application.

Bone Diseases, Developmental↗
PubMedDate not supplied

Treatment of congenital pseudarthrosis of the tibia: a multicenter study in Japan.

Treatment of congenital pseudarthrosis of the tibia (CPT) remains a challenge. To clarify the current situation in treatment, a multicenter study was carried out to obtain information on the results of CPT treatment. The objective of this study was to propose appropriate treatment guidelines for CPT. Records of 73 patients with CPT who underwent surgical treatment were collected from 32 hospitals. The modality of the treatment was 26 with Ilizarov technique, 25 with free vascularized fibular graft, 7 with a combination of the two techniques, 6 with intramedullary nailing with free bone grafting, 5 plating with free bone grafting, and 4 with other treatments. Fifty-four procedures resulted in union, 7 resulted in delayed union, 7 were left un-united, 1 underwent amputation, and the results were unknown in 4. According to the results of this study, the most acceptable methods of treatment of CPT are the Ilizarov method and the vascularized fibular graft.

Adolescent↗
PubMedDate not supplied

Congenital pseudarthrosis of the fibula.

Three cases of congenital pseudarthrosis of the fibula are reported, all with prepseudarthrotic involvement of the omolateral tibia. In patients with this condition, correction of valgus deformity should be deferred until puberty, and the occurrence of tibial fractures should be prevented by means of leg splints.

Child↗
PubMedDate not supplied

Congenital pseudarthrosis of the tibia: treatment with free vascularized fibular grafts.

We used free vascularized fibula transfers to treat 12 patients with congenital pseudarthrosis of the tibia. The mean age at surgery was 6.5 years, and the average follow-up was 3.4 years. Only one patient had persistent nonunion at the time of last follow-up, but he had 2.2 operations after the initial vascularized procedure. Problems included delayed union at the distal anastomosis and refracture. Union can be achieved in most patients, but attention to technical detail is very important. All angulation must be corrected and, at the first sign of delayed union, the site should be regrafted and intramedullary fixation should be used.

Adolescent↗
PubMedDate not supplied

Treatment of congenital pseudarthrosis of the tibia by the Ilizarov method.

Three cases of congenital pseudarthrosis were treated by the Ilizarov method. Consolidation was obtained by 3.5 months in three patients who had undergone several previous surgical procedures. Although the length of follow-up was short (maximum 3.5 years), consolidation occurred more quickly than by traditional methods. This technique also permitted both simultaneous correction of axial malalignment and leg lengthening. We think that this method has a place as a salvage procedure except where the distal fragment is very thin or dystrophic.

Bone Lengthening↗
PubMed1979

Congenital pseudarthrosis of the ulna: a case report.

A case of congenital pseudarthrosis of the ulna is described. The inevitability of dislocation of the radial head in the early years of life, is pointed out. Following dislocation of the radial head, creation of a stable single-bone forearm is necessary to prevent loss of hand function due to effective shortening of the long flexors. A method of radioulnar fusion is described. Following such fusion good hand function can be anticipated, as the vital humeroulna radiocarpal joints are intact.

Child↗
PubMed1995

Pseudarthrosis of the acromion--a differential diagnosis in anterolateral shoulder pain.

A case of longstanding posttraumatic anterolateral shoulder pain in a 25-year-old woman is presented. It was primarily unsuccessfully handled as impingement syndrome but turned out to be caused by pseudarthrosis of the acromion. The abnormality was not apparent on plain X-ray film. The suspicion was raised after scintigraphy, which showed increased density in the acromion. The diagnosis was made by computerized tomography and confirmed and treated successfully surgically.

Acromion↗
PubMed1992

Orofaciodigital syndrome type I in a girl with unilateral tibial pseudarthrosis.

The orofaciodigital syndromes are a group of possibly seven different malformation syndromes including oral, facial, and digital malformations. Type I has X linked dominant inheritance whereas the other types show autosomal recessive inheritance. An exact diagnosis is therefore important for genetic counselling. We here report a girl with orofaciodigital syndrome type I. She had cystic kidney disease at the age of 8 months which has not previously been reported in an infant with orofaciodigital syndrome. In addition she had unilateral tibial pseudarthrosis which has only rarely been reported in the orofaciodigital syndromes and in type II only.

Child, Preschool↗
PubMed2006

Residual nonunion following vascularised fibular graft treatment for congenital pseudarthrosis of the tibia: a report of two cases.

Resection and reconstruction using a vascularised fibular graft is a viable alternative treatment for congenital pseudarthrosis of the tibia, although distal junctional nonunion and residual deformity are known complications that are difficult to treat. We illustrate 2 cases in which bony union was achieved following a technique using fibular grafting and intramedullary nailing, without additional bone grafting. This technique was feasible because of hypertrophy of the fibular graft.

Bone Transplantation↗
PubMed1976

The aetiology of congenital angulation of tubular bones with constriction of the medullary canal, and its relationship to congenital pseudarthrosis.

It is suggested that there is a group of cases of congenital angulation of tubular bones in which the lesion is a defect of ossification of the primary cartilaginous anlage and in which neurofibromatosis is not implicated. It appears that in this group the prognosis with regard to the resolution of deformity and the prevention of pseudarthrosis with conservative treatment or relatively simple surgical procedures is better than that in the neurofibromatous type.

Adolescent↗
PubMed1985

Electrical stimulation in the treatment of congenital pseudarthrosis of the tibia.

A treatment regime using electrical stimulation in association with a variety of surgical procedures has improved the prognosis in congenital pseudarthrosis of the tibia--one of the most challenging of all orthopaedic disorders. The technique consists of correction of the tibial deformity, intramedullary fixation and cancellous bone grafting, augmented by electrical stimulation using an implanted bone-growth stimulator. Experience with 27 pseudarthroses in 25 patients is presented; of those, 20 have joined. The cases have been reviewed and the causes of failure analysed. These results offer encouragement to the orthopaedic surgeon treating this difficult condition.

Child↗