[Pseudarthrosis in the course of osteogenesis imperfecta tarda].
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A case of pseudoarthrosis and partial resorption of the ulna in a 12-year-old girl with neurofibromatosis is described. Neurofibromatosis is a common neurocutaneous disease with characteristic osseous lesions. The pseudoarthrosis in this case developed after fracture. The bone most commonly affected is the tibia and involvement of the ulna has been reported in only a few cases. The possible cause of pseudoarthrosis, the radiographic changes, and the treatment are discussed.
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The aim of this paper was to assess the results of treatment of pesudoarthrosis of the tibia and femur with reamed interlocked intramedullary nailing. A group of 17 patients with pseudoarthrosis of long bones were treated. Pseudoarthrosis were located in 10 cases in the tibia and in 7 cases in the femur. In the analysed group there were 14 male and 3 female patients (average age: 48 years). All patients were treated by locked intramedullary nailing. Complete bone union was observed in 15 cases, 1 case is still under observation (radiological signs of bone union are already evident) and in 1 case treatment failed to resolve the pseudoarthrosis. Intramedullary interlocking nailing in the treatment of long bone pseudoarthrosis give very good stability and creates very good conditions for blood vessel penetration between the bone fragments. The reaming procedure yields biologically active material that accelerates the bone union process.
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The present paper reports on 20 cases of old fractures and pseudoarthrosis of the carpal scaphoid operated in the Clinic of Ortopaedics and Traumatology of the "Brîncovenesc" Hospital and followed up over an 8 year period (1965--1972). The treatment, exclusively surgical, consisted in: osteosynthesis with corticospongious graft, combined with styloidectomy (9 cases); excision of the necrosed fragment and styloidectomy (7 cases); and one case each of osteosynthesis with aid of a screw, simple styloidectomy, explorative arthrotomy and arthrodesis of the wrist. The best result were obtained after osteosynthesis with styloidectomy, performed for various forms of pseudoarthrosis with moderate ischemia, and after partial scaphoidectomy for necrosis with a small proximal fragment.
The authors have observed three cases of fractures at the thoraco-lumbar level which did not unite after ten to twelve months - Dynamic X-rays demonstrated persisting mobility of about 20 degrees. The fracture line of the vertebral bodies was situated in a frontal plane and fragments were separated by the antero-inferior edge of the above vertebral body. The authors conclude that such fractions ought to be treated by internal fixation when recent, internal fixation and grafting when ancient.
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