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A 10-year-old boy who sustained a fracture through a cyst in the ulna later developed a pseudarthrosis. During 13 years' follow-up the characteristic short bowed forearm developed but, instead of the more usual spontaneous dislocation of the head of the radius, the patient also developed the previously unreported complication of osteoarthritis of the elbow.
A woman with neurofibromatosis (von Recklinghausen's disease) presented with a giant plexiform neuroma of the arm and chest wall, with dysplastic scoliosis and a pseudarthrosis of the humerus. Her arm resembled that of the "Elephant Man" described by Sir Frederick Treves.
We reviewed 40 extensive destructive vertebral lesions in 35 patients with established ankylosing spondylitis. Of these, 31 had presented with localised pain while three had a neurological deficit. The radiographs suggested ununited fractures through either ankylosed discs (37) or vertebral bodies (3). Corresponding fractures were seen in the posterior column in 34 cases. Sixteen patients with 18 lesions underwent anterior spinal fusion, and pseudarthrosis was consistently proven by histopathology. Two pseudarthroses healed in conservatively treated patients. Thirteen of the operated patients were followed for an average of 7 years 7 months. There were two cases of non-union and one required an additional posterior fusion; in the remainder fusion was sound.
We report the long-term results of the Matti-Russe operation for pseudarthrosis of the scaphoid in 100 cases, reported previously by Mulder in 1968. Clinical results for 77 patients and radiographic data for 74 were reviewed at 22 to 34.8 years after surgery. In general, there was satisfactory relief of pain and stiffness but some patients had limitation of motion and reduced grip-strength, with usually slight osteoarthritic changes. There was poor correlation between subjective, objective, and radiographic results but 88% of the patients were satisfied with their results.
Five children with congenital pseudarthrosis of the tibia treated by free vascularised fibular grafts were followed up until skeletal maturity. The ipsilateral fibula was used in four cases, the contralateral fibula in one. All our cases achieved bone union, but leg length discrepancy, atrophy of the foot and ankle stiffness were frequent complications, due perhaps to the many previous operations. Vascularised fibular grafting might achieve better results if it were done as the primary procedure.
We describe a 13-year-old boy with atrophic tibial pseudarthrosis associated with neurofibromatosis who had undergone nine unsuccessful operations. Eventually, union was obtained by the use of bone morphogenetic protein 7 in conjunction with intramedullary stabilisation and autologous bone graft.
Congenital pseudarthrosis of the clavicle is a rare anomaly in which the clavicle is formed in utero in two separate segments. Clinically, there is a bump and a palpable discontinuity at the middle of the clavicle. There is no swelling or tenderness, nor disability. Radiologically, the medial ends of both clavicular segments are blunt and there is no interruption of cortical bone. The differential diagnosis includes birth fracture of the clavicle and craniocleidal dysostosis. The obstetrician should be aware of this condition as, if it is misdiagnosed, he may be wrongly accused of birth fracture.
On the basis of 21 cases of congenital pseudarthrosis of the tibia, which were radiologically typed and later personally examined, it was found that all cases of the dysplastic type also showed evidence of neurofibromatosis. No evidence of neurofibromatosis was found among the cystic and the clubfoot type of pseudarthroses.
This report concerns 105 patients who developed painful necrosis or pseudarthrosis after nailed transcervical femoral fractures and were treated by Moore's arthroplasty. The mean age at the time of secondary arthroplasty was 68 years, the operation being performed on average 2 years after the fracture and nailing. The mortality within 6 weeks of operation was 3 per cent. Complications not producing late sequelae were seen in 11.4 per cent of cases, and complications producing late sequelae occurred in 5.7 per cent. At the follow-up examination 2 to 8 years after arthroplasty (mean 3.7 years), 37 per cent of the patients were completely free from pain, and the functional result was acceptable in 91 per cent. The remaining 9 per cent had other debilitating illnesses. The results are compared with other reports in the literature.
Six patients with posttraumatic pseudarthrosis of the clavicle were treated during 1973 and 1974 with an operative technique consisting of trimming of the bone ends, placement of a cortical bone transplant posteriorly and metal plate anteriorly, and fixation of the plates with screws. At examination 10-23 months postoperatively complete healing had been achieved in all cases.
Congenital pseudarthrosis of the clavicle is a rare entity. Its aetiology and pathogenesis still remain obscure. The condition is predominantly right-sided. Differential diagnosis lies between birth fracture and cleido-cranial dysostosis. Surgery when indicted gives good results.
Three children with pseudarthrosis of the tibia after osteomyelitis and extensive sequestration of the diaphysis were operated according to Hahn with transfer of the fibula to the proximal part of the tibia at ages 2-9 years. Because of damage to the distal growth plate, secondary to the infectious process, epiphyseodesis of the proximal ends of the tibia and fibula on the unaffected side was necessary to reduce the length discrepancy. Restored continuity of the tibial diaphysis resulted in restored longitudinal growth proximally and in increased diaphyseal width. In all three cases the operation resulted in good weight-bearing limbs with only slight residual disability at adult age. Hahn's original method is simpler and in children may result in a limb which is closer to normal than the modifications of his method.
Four patients with neurofibromatosis and a dysplastic type of congenital pseudarthrosis of the tibia were treated by resection of the lesion and reconstruction of the extremity with a free vascularized fibular graft. Solid union of the graft was achieved within 3 months in 3 children. However, valgus malalignment of the tibia progressed in all 3. One child was treated with resection of a lateral fibrotic band and another with distal tibial epiphysial distraction and realignment. In the fourth patient, who was skeletally mature, a nonunion developed proximally.
The authors analyse the etiology and treatment of 18 pseudarthroses of the tibial diaphysis occurring in a series of 320 fractures of this bone. This complication seldom appears in simple fractures treated by a plaster cast (two cases out of 144). In addition to classical and well known factors, it appears that pseudarthrosis occurs more frequently after traction-immobilization (10 cases out of 73), when the fragments had to be repositioned on many occasions under plaster cast, or in cases of open fractures. The treatment by bone grafting, principally in-lays, with or without plates and visses, yield satisfactory results.
PURPOSE OF THE STUDY: Bipartite scaphoid has long been debated, and is of traumatic origin for some authors or congenital for others. The aim of the study is to distinguish clinical and radiographic criteria for the diagnosis of congenital bipartite scaphoid. MATERIAL AND METHOD: A case of bilateral bipartite scaphoid is presented. To distinguish pseudarthrosis from congenital bipartite scaphoid we used, the revised carpal height ratio of Nattrass, the CT, and magnetic resonance imaging. RESULTS: These examinations showed no collapse and they revealed evidence of articular cartilage around the fragments with the same thickness in all the carpus. CONCLUSION: We believe that congenital origin is more probable but we recommend to follow the patient, with yearly standard wrist radiograph and use, the revised carpal height ratio of Nattrass to research a carpal shift or collapse.
Pseudarthrosis of the midshaft of the clavicle can be treated successfully using the Herbert cannulated bone screw with no need for a second operation to remove the implant after bone union.
The authors present a case of acquired, untreated pseudarthrosis of the tibia which resulted in adaptation to the weight-bearing function by the fibula. The case described shows the adaptation abilities of the bone tissue which, when subjected to unusual loading, undergoes the necessary reconstruction.
A 22-year-old man with pseudarthrosis and infection of the right hip was referred for a 67Ga-citrate scan. A striking decrease was seen in normal bone and soft-tissue uptake in the entire right leg compared with the normal limb. Aortic injection of 99mTc-labeled microspheres showed increased trapping in the region of the hip but contrast angiography was unremarkable. Despite clinical imporvement, 67Ga uptake by the right leg on a repeat scan did not return to normal. This case represents the first report of a "photon-deficient" body part on 67Ga scanning.