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Non-union of the capitate is rare. So far, six cases of non-union have been reported. The authors add a new case report, involving a 29-year old tobacco worker with a typical history. The length of the capitate was restored by corticocancellous bone grafting. The mechanism by which non-union occurs is discussed, showing that the uninjured palmar V ligament in the wrist is responsible.
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In the article are presented the peculiarities of creation and development of congenital false joints of the crus bones, worked out a new modern classification of pseudoarthroses with regard to their etiology and phasic development. For the first time, on the basis of cloning of the osteogenic cells--precursors, there have been carried out studying of osteogenic "potencies" of the zone of congenital false joint and "soundness" of transplanted autospongiosa of the upper flaring portion of the ilium. There is presented a differentiated approach to utilization of different plastic materials (autospongiosa, allogenic decalcified bone matrix). There have been developed new methods of prophylactic and reconstructive--restorative osseoplastic operations in children with false joints of the crus bones.
On the basis of 274 observations the authors stated the conception of staged roentgenologic course of the osseous tissue regeneration in case of close distraction of rigid false joints according to G. A. Ilizarov. In line with visual appraisal of roentgenograms there were used roentgenometry and densitometry. There are described in details the stages of reparative regeneration and in accordance with them are given the tactical recommendation as to the selection of the distraction rate and its duration, the terms of loading and immobilization of fractures by means of perosseous apparatus. The tactics of the patient control with regard to the peculiarities of osteogenesis in the process of distraction allowed to decrease the number of failures in treatment of false joints by 2 times.
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Non union of the olecranon is rare, resulting from inadequate or failed primary internal fixation, or from extension immobilization. Olecranon non unions can generally be handled by open reduction and strong internal fixation with or without application of a bone graft. We also observed radiographic evidence of non union in several patients with full range of motion and no pain. In these cases the non union slowly but spontaneously healed.
A new case of congenital nonunion of the clavicle is reported with a histological description. Medullar drilling and bone grafting "in loco" was performed during the surgical procedure. The etiologic hypotheses are discussed. The authors compare congenital nonunions between the pathologies associated with the necessity of medullar drilling for consolidation.
Authors briefly summarized the classification, the causes and origin of the pseudoarthroses. The pseudoarthrosis of the olecranon may play an important role in the development of the disturbances of the movement in the elbow joint. In connection with 3 cases of their own the possibilities to restore the badly damaged joint and to eliminate function disturbances are demonstrated.
Sixty-three first, second, or third-time repairs of one or more pseudarthroses were done in fifty-one patients who had had an arthrodesis for idiopathic scoliosis. Forty-five of the patients were female and six were male. The average age was 30.2 years. The indications for the sixty-three repairs were pain (twenty-five repairs), progression of the curve (sixteen), both pain and progression of the curve (twelve), and radiographic changes only (ten). Failure of the implant was identified before 27 per cent of the sixty-three procedures. The pseudarthroses were diagnosed an average of 2.8 years after the initial arthrodeses. Sixty-eight per cent of the defects were visible on plain radiographs preoperatively and 32 per cent were identified at operation. During the time between the original arthrodeses and the repairs of the pseudarthroses, the scolioses increased by a mean of 7 degrees and the kyphoses, by a mean of 10 degrees. Harrington distraction was the most commonly used instrumentation (twenty-six [41 per cent] of the sixty-three procedures), and autogenous iliac bone was the most commonly used material for the graft (thirty-three [52 per cent] of the procedures).
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The authors report the case of a nonunited supra-malleolar fracture with severe angulation in an elderly patient. Poor vascular condition and severe osteoporosis prevented the use of either a surgical approach or internal fixation. Gradual realignment and union were nevertheless achieved within 6 months post operatively using the "Sequoïa" external fixation system, while weight-bearing was continued throughout the course of treatment.
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