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Results for “PSEUDARTHROSIS”

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At least 613 records · Page 34Linked to original sources
PubMed1999

[Persistent scaphoid pseudarthrosis after surgical treatment: results of repeated bone transplantation].

From 1984 to 1993, 30 patients with persistent scaphoid non-union despite bone grafting procedures underwent additional reconstructive surgery. Twenty-five patients were followed-up between one and eleven years after revision with a mean follow-up time of 4.8 years. Fifteen patients had bone graft procedures alone, ten patients had additional internal fixation with the Herbert screw or Ender plate. At follow-up, scaphoid union was achieved in 16 patients (64%), 19 patients had arthritic changes of the radiocarpal joint. Only patients with scaphoid union showed satisfactory functional results. Five patients with failed revision surgery needed further operations for chronic wrist pain, including three wrist arthrodeses.

Adolescent↗
PubMed1999

[Relation of necrosis to outcome and site of fracture in scaphoid pseudarthrosis].

Usually, untreated scaphoid fractures lead to non-union and partial or complete avascular necrosis. The purpose of our study was to examine the influence of location and fracture line on the pattern of necrosis. Therefore, 85 patients with scaphoid non-union were examined by enhanced highfield MRI. Fractures were classified by location and fracture line. A staging system based on signal intensity in T1-weighted spin-echo sequences in enhanced MRI was used to evaluate extent and location of avascular necrosis, which was found in 81% of our patients. In our patients, viability of the scaphoid was independent of the fracture line without dominance of vertical oblique fractures (2%). Based on our staging system, signal intensity as a sign of fragment viability was reduced in the proximal fragment in 46 patients, whereas in eight patients the distal fragment showed reduced viability. In 26 patients, no difference was found between proximal and distal fragments. Fractures proximal to the transition of middle to distal third showed less viability of the proximal fragment, not dependent of how proximal the fracture was seen. In triple fractures (6%) signal intensity of scaphoid bone was more reduced in enhanced MRI.

Adult↗
PubMed1994

[The MRT of scaphoid pseudarthrosis with Gd-DTPA. Its staging and clinical correlation].

During a period of two years, 134 patients with pseudo-arthrosis of the scaphoid were examined by conventional radiography and by MRI in the course of a prospective study. The aim of the study was to define radiological staging using contrast enhanced MRI in order to improve the prognostic criteria. All MRI examinations were carried out with a 1.5 tesla scanner (SP63) using a surface coil and T1 weighted spin echo sequences in sagittal and frontal projection and frontal FLASH T2 sequences and axial spin echo T2 sequences. The T1 weighted SE sequences in frontal projection were carried out before and after iv contrast (0.1 mmol Gd-DTPA/kg KG). All sequences were compared with conventional radiographs and the operative findings. Eight patients in stage 0 showed high signal intensity of both fragments in T1 weighted SE sequences and at surgery there was good vascularisation. In 22 cases there was reduced signal intensity in at least one fragment (stage I). 45 patients with scaphoid pseudo-arthrosis showed complete signal loss but marked contrast uptake with still vital nuclei at surgery (stage II). In 22 patients, there was no increase in signal intensity after contrast and complete loss of vitality of the fragments at surgery. Staging was not possible in 37 patients because of previous operative intervention. The use of contrast enhanced MRI provides additional information compared with conventional radiography or plain MRI.

Adolescent↗
PubMedDate not supplied

[Problems in the surgical treatment of congenital pseudarthrosis of the lower leg].

The principal aim of this study was to describe the frequent errors that are being committed when treating congenital pseudarthroses of the lower leg. The authors studied this in 25 patients. 21 of these were referred to surgery, whereas 4 were presented by colleagues seeking counsel and were then subjected to further treatment at another location. One-half of the 21 congenital pseudarthroses had already been unsuccessfully operated on in other hospitals up to as often as four times. The method of "combined plate osteosynthesis" was employed with 19 of the 21 patients; this method was originally developed by W. Blauth and used for the first time in 1969. Witt and Refior reported on a similar technique at about the same time and independently thereof. 17 of our patients were cured; 2 failures cannot be blamed on the method. The main procedural error in the previously operated patients had been a misjudgement of the disease pattern which is characterised by "biological deficiency" and lack of load-bearing capacity of the bones of the lower leg in a circumscribed region at the transition from the median to the lower third of the lower leg. Another important factor was certainly the lack of knowledge of the pathogenetic significance of the pathologically affected periosteum. In this connection the failures were certainly also conditioned by faulty osteosyntheses resulting therefrom, without using autologous osseous material for grafting; by operating too early; by immobilising the limbs postoperatively for too short a period; and by insufficient relief of the limbs before a patent medullary cavity had formed. Another error consisted in omitting to perform autologous bone chip implantation at the same time when removing osteosynthesis material. The authors conclude that congenital pseudoarthroses of the lower leg can in all probability be remedied already in early childhood if the well-tried principles of treatment of "combined plate osteosynthesis" are observed. This, however will not result in normal lower leg bones, as can be concluded from the fact that spontaneous fractures have occurred partly even in the locomotor apparatus after the pseudarthroses had healed. In future, petiolated bone grafts performed by microsurgeons should be promising and competitive. Küntscher nail osteosyntheses should also offer good chances of healing if performed from the site of the sole. Their main drawbacks might be damage of the distal tibial epiphysis and of the functions of the ankle joint and talo-calcaneonavicular joint.

Adolescent↗
PubMed1989

[Pseudarthrosis of the scaphoid: frequency, pathogenesis and course].

Eight-three scaphoid pseudo-arthroses were found amongst 1.104 scaphoid examinations. Sixty-seven were present at the first examination and 16 pseudoarthroses developed amongst 252 scaphoid fractures. Men were affected predominantly, particularly in the 20 to 40-year old group. Fractures in the proximal third of the scaphoid and vertical oblique fractures had a particular tendency to pseudo-arthrosis formation. The operative treatment of choice is a Matti-Russe bone graft. Only one patient in seven with definite scaphoid pseudo-arthrosis showed firm fusion.

Adult↗
PubMedDate not supplied

[Morphologic and clinical aspects in the treatment of infected shaft pseudarthrosis].

By means of clinical and morphological findings the procedure in the treatment of infected diaphyseal non-unions is described. The necessity of adequate stabilization--especially with the help of the external fixatoris pointed out. The infected cortex, often as a compromise, has to be left in place in order to give a foundation for periosteal bone grafts. Such cortical bone which is not vascularized and prevents the infect from subsiding has to be removed in a second step from a medullary approach. The defect is then filled up with autologous cancellous grafts. In the forearm the whole infected area of bone can be removed and replaced by a cortico-cancellous graft which is stabilized by internal fixation with a plate.

Bone Transplantation↗