Congenital pseudarthrosis of the tibia: Part 1. European Pediatric Orthopaedic Society multicenter study of congenital pseudoarthrosis.
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Twenty-nine patients with thirty pseudarthroses after removal of infected total hip prostheses have been reviewed one to six years later. Six hips still had a discharging sinus. Complete removal of all cement was found to be essential for healing, and various points in the technique of its clearance have been made. In this respect radio-opaque cement was a great advantage, and lateral guttering of the femur was most effective. Compared with the situation before replacement considerable relief of pain was obtained in most patients but there was much less improvement in function.
We have performed simple bone grafting in four elderly patients with pain due to unstable pseudarthroses in the osteoporotic spine after compression fracture. At operation, we observed abnormal movement of the affected vertebral body which was covered with a hypertrophic membrane; this seemed to inhibit the blood supply to the lesion. The thick membrane and avascular granulation in the false joint were excised and bone grafting carried out. Symptoms were dramatically improved immediately after operation and bony union was confirmed in the three surviving patients.
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In patients with symptomatic scaphoid nonunion there was an increased evidence of progessive osteoarthrosis expressed as instability of the wrist; it is defined as a scapholunate angle more than 70 degrees or a radiolunate angle of more than 10 degrees. We tried to determine the factors of risk and prognostic indicators of degenerative arthritis. In this study 40 patients with painfull nonunion of the scaphoid were analysed. Duration of nonunion was not in correlation with development of osteoarthritic changes (p=0,644; p>0,05). Progessive degenerative changes correlated well with radiolunate angle (p=0,398; p<0,05), kapitolunate angle (p=0,381; p<0,05) and carpal index (p=0,392; p<0,05). The average values of intercarpal angles increased with progression of osteoarthritic changes. There was a statistically strong corelation between location of fracture in proximal third and presence of degenerative changes (p=0,341; p<0,01). Intesity of arthritic changes showed no statistically significant correlation regarding untreated fractures (p=0,665; p>0,05). We recommend that a scaphoid nonunion associated with carpal instability should be operated before degenerative changes develop.