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PubMed1975

Reflections upon the aetiology of congenital pseudarthrosis of the clavicle. With a note on cranio-cleido dysostosis.

The cause of pseudarthrosis of the clavicle is obscure. Right-sidedness is an almost constant feature. We have proposed that the lesion is sometimes due to pressure upon the developing clavicle by the subclavian artery which is normally at a higher level on the right side. This may be accentuated in the presence of cervical ribs or unduly elevated first ribs, both of which we have observed in association with pseudarthrosis. We have also noted pseudarthrosis on the left side in association with dextrocardia (when the relative positions of the subclavian arteries are reversed) and in the presence of a large left cervical rib. We have speculated upon the nature of the clavicular defect in cranio-cleido dysostosis, in which disorder the first ribs are habitually elevated. A similar mechanism may be involved.

Bone Diseases, Developmental↗

PubMed2002

Congenital pseudarthrosis of the tibia: results of technical variations in the charnley-williams procedure.

BACKGROUND: Results of the Charnley-Williams method of intramedullary fixation for treatment of congenital pseudarthrosis of the tibia have varied, in part because of variations in surgical technique. The outcomes of three variations of this procedure were compared to determine which technique was the most likely to result in union. METHODS: The results in twenty-three consecutive patients with congenital pseudarthrosis of the tibia were reviewed at four to fourteen years following initial surgical treatment with an intramedullary rod. Three types of procedures were performed: type A, which consisted of resection of the tibial pseudarthrosis with shortening, insertion of an intramedullary rod into the tibia, and tibial bone-grafting combined with fibular resection or osteotomy and insertion of an intramedullary rod into the fibula; type B, which was identical to type A except that it did not include fibular fixation; and type C, which consisted of insertion of a tibial rod and bone-grafting but no fibular surgery. The outcome was classified as grade 1 when there was unequivocal union with full weight-bearing function and maintenance of alignment requiring no additional surgical treatment; grade 2 when there was equivocal union with useful function, with the limb protected by a brace, and/or valgus or sagittal bowing for which additional surgery was required or anticipated; and grade 3 when there was persistent nonunion or refracture, requiring full-time external support for pain and/or instability. RESULTS: Eleven patients (48%) ultimately had a grade-1 outcome; nine, a grade-2 outcome; and three, a grade-3 outcome. The final outcome was not associated with either the initial radiographic appearance of the lesion or the age of the patient at the time of the initial surgery. The results following type-A and B operations were better than those after type-C procedures. Surgery on an intact fibula resulted in a lower prevalence of grade-3 outcomes than was found when an intact fibula was not operated on (p = 0.05). Transfixation of the ankle joint by the intramedullary rod did not decrease the prevalence of grade-3 outcomes. CONCLUSIONS: There is little justification for a type-C operation, as it either resulted in a persistent nonunion or failed to improve an equivocal outcome in every case. Leaving an intact fibula undisturbed to maintain stability or length also was not successful in this series. In addition, the presence of fibular insufficiency (fracture or a pre-pseudarthrotic lesion) was highly prognostic for subsequent valgus deformity (occurring in ten of twelve cases), whether or not the fibula eventually healed.

Adolescent↗

PubMed2004

[Treatment results of pseudarthrosis of the humeral shaft by open reduction and internal fixation with dynamic compression plating].

OBJECTIVES: We evaluated the results of open reduction and internal fixation with the use of dynamic compression plating in patients with pseudarthrosis of the humeral shaft. METHODS: Eighteen patients (12 males, 6 females; mean age 41 years; range 22 to 68 years) with aseptic pseudarthrosis of the humeral shaft were treated by open reduction and internal fixation with the use of a dynamic compression plate following unsuccessful treatment with conservative (n=7) or surgical (n=11) methods. The mean interval between the initial and final treatments was 12.2 months (range 5 t 46 months). Exploration of the radial nerve and autogenous corticocancellous grafting were simultaneously performed in all the cases. Functional results were evaluated according to the Stewart-Hundley's criteria. The mean follow-up was 38.8 months (range 12 to 78 months). RESULTS: Union was achieved in all (94.4%) but one patient within a mean duration of 5.5 months (range 3 to 8 months). Functional results were good in fourteen patients (77.8%), fair in three patients (16.7%), and poor in one patient (5.6%). Radial nerve palsy that occurred in two patients during the early postoperative period underwent spontaneous recovery within three and five months, respectively. Mild reflex sympathetic dystrophy developed in two patients. CONCLUSION: In selected patients with pseudarthrosis of the humeral shaft, the results of open reduction and internal fixation with the use of dynamic compression plating are excellent, provided that an appropriate surgical technique is employed.

Adult↗

PubMed1991

Ilizarov apparatus for infected pseudarthrosis of the spine: a case report.

A case is presented of a 13-year-old girl with thoracic level myelomeningocele who developed an infected pseudarthrosis of the lumbar spine after an attempted kyphosectomy. The pseudarthrosis was successfully united through the use of special modifications of the Ilizarov apparatus. Rings and wires were applied to the iliac wings below and the thoracic laminae above the pseudarthrosis site. Preoperative planning was aided by a CT scan of the pelvis and spine. A cut-out foam mattress and a special wheelchair were used postoperatively to facilitate patient care.

Abscess↗

PubMed2006

[Treatment of congenital pseudarthrosis of tibia by vascularized fibular graft].

PURPOSE OF THE STUDY: The aim of the study was to evaluate the results in a group of patients with congenital pseudarthrosis of the tibia treated by transfer of a vascularized fibular graft from the contralateral extremity. MATERIAL: The group included three boys and two girls aged 2 to 8 years at the time of surgery. In two patients, the vascularized graft transfer was preceded by other operations. All patients but one had Crawford type IV pseudarthrosis. The signs of peripheral neurofibromatosis were found in four of the five patients. METHODS: The operation was carried out by two surgical teams, i. e., orthopedic and microsurgery (plastic surgery) specialists. Deep dissection of the pseudarthrosis was performed down to healthy, well vascularized tissue; a vascularized pedicle bone graft was harvested from the contralateral fibula. The graft was inserted and anchored intramedullarily in both tibial fragments, and stability was provided with a K-wire introduced through the calcaneus. Subsequently, the vascular pedicle of the fibular graft was joined to the surrounding vessels (anterior tibial artery and anterior tibial vein). The extremity was immobilized in plaster cast and later a KAFO brace was applied. RESULTS: Graft union partially failed in the proximal end of the graft due to bone resorption of both the graft and the proximal tibial fragment in two patients. This was successfully treated by additional spongioplasty. In all patients bony union was achieved at an average time of 9.8 months (range, 6 to 21 months). An increase by more than 100 % in the diameter of the transplanted fibula was recorded in four patients. The increase, which was of course related to follow-up time, was a clear proof of primary graft vascularization. DISCUSSION: The use of vascularized fibular graft harvested from the contralateral extremity showed high effectiveness in comparison with other methods. This was in agreement with the relevant literature reports. CONCLUSIONS: This method can be used regardless of patients' age and our experience showed that, even in small children, union can be achieved and can thus allow for early weight-bearing and prevention of crus atrophy.

Bone Transplantation↗

PubMed2006

Congenital pseudarthrosis of the clavicle: the role of CT-scanning.

Congenital pseudarthrosis of the clavicle is a rare entity. It presents on the right side in 90% of the patients, and bilaterally in up to 10%. The authors report the case of a 4-year-old boy who presented with a painful deformity over his right mid-clavicular area. Plain radiographs were inconclusive, although the opposite is true in most cases. A computed tomography (CT) 3-D reconstruction showed a pseudarthrosis of the clavicle, and excluded a neoplastic, infective or traumatic origin. Treatment involved excision of the pseudarthrosis, internal fixation with a contoured reconstruction locking plate, and bone grafting. The authors prefer operative treatment, but this is not universally accepted.

Child, Preschool↗

PubMed1991

Congenital constriction band associated with pseudarthrosis and impending gangrene. A case report.

A newborn baby with a severe congenital constriction band associated with pseudarthrosis and impending gangrene of the foot is described. Early one-stage circumferential excision of the band with immediate wound closure by multiple Z-plasties salvaged the compromised foot. The pseudarthrosis indicated the severely compressive nature of the fibrous band. The uneventful healing of the pseudarthrosis and the full recovery of neurovascular function points to essential normal tissue underlying the constricting band.

Constriction, Pathologic↗

PubMed1991

Revision arthrodesis for tibiotalar pseudarthrosis with fibular onlay-inlay graft and internal screw fixation.

Pseudarthrosis after failed tibiotalar arthrodesis was successfully treated surgically in nine of 11 patients between 1980 and 1987. The indication for the initial attempted arthrodesis was traumatic arthrosis in seven patients, traumatic arthrosis with osteonecrosis of the talus in two patients, degenerative arthrosis in one patient with cavovarus foot (Charcot-Marie-Tooth), and myelodysplasia with progressive valgus deformity of the foot and ankle in one. The surgical technique planned for revision arthrodesis provided firm coaptation of tibia to talus with internal fixation that maintained the foot at right angles to the tibia with the forefoot in neutral position. Seven feet in 11 patients were treated using a transfibular approach that allowed excision of fibrous tissue and sclerotic bone, decortication of the media malleolus, fixation of the tibia to the talus with cancellous screws, and onlay/inlay fibular graft. Of the remaining four patients, one was treated with medial compression plate, a second was treated using an anteromedial cortical graft, a third was treated by a combination of sliding anteromedial corticocancellous graft and tibiotalar compression screw, and a fourth was treated with tibiotalar compression screw. Clinical and roentgenographic union occurred in nine of 11 patients. One patient developed a painless, fibrous union and one patient with persistent pseudarthrosis had myelodysplasia and severe valgus deformity and required amputation. Adequate exposure was possible through the transfibular approach to provide cancellous bone opposition, to excise the pseudarthrosis membrane and sclerotic bone, and to remove necrotic segments of the talus. In addition, supplemental bone graft, internal fixation, and postoperative cast immobilization were also helpful in obtaining union.

Adolescent↗

PubMedDate not supplied

Pseudarthrosis of the radius associated with neurofibromatosis: report of a case and review of the literature.

An 11-year-old child with pseudarthrosis of the radius associated with neurofibromatosis was treated by conventional bone graft. Five years after the operation, the pseudarthrosis united, but the grafted bone was slightly sclerotic and bowed. This article describes the clinical findings and postoperative results, and discusses the current surgical approaches in the treatment of pseudarthrosis of the radius.

Bone Transplantation↗

PubMed1989

[Considerations on the principles of treatment of aseptic pseudarthrosis of the leg with the Ilizarov method].

The surgical treatment of aseptic pseudarthrosis of the leg may be summarised in the following methods, the indications of which are based on the features of the centre of the lesion: hypertrophic or closed pseudarthrosis: paraosteal osteosynthesis with a plate; osteoperiosteal decortication and autoplastic bone transplant; intramedullary osteosynthesis (Küntscher, Rush); external osteosynthesis; plaster; atrophic or lax pseudarthrosis: paraosteal osteosynthesis with a plate; osteoperiosteal decortication and autoplastic bone transplant; intramedullary osteosynthesis (Küntscher, Rush); fibula-pro-tibia; intertibio-fibular transplant.

Fibula↗

PubMed1987

Congenital pseudarthrosis of the tibia associated with cleidocranial dysostosis and osteogenesis imperfecta. A case report.

A neonatal boy with cleidocranial dysostosis presented with congenital pseudarthrosis of the tibia. Clinical observation later revealed he also had osteogenesis imperfecta. The osteogenesis imperfecta was classified as Type I and the congenital tibial pseudarthrosis as Type II. Cleidocranial dysostosis, osteogenesis imperfecta, and congenital pseudarthrosis of the tibia have not been previously reported to coexist in one individual.

Abnormalities, Multiple↗

PubMed1986

Treatment of infected pseudarthrosis of the femur and tibia with an interlocking nail.

Between 1970 and 1977, 64 patients with infected pseudarthrosis of the femur and tibia were treated with an interlocking nail. The type of primary treatment prior to the development of the infected pseudarthrosis was plate fixation in 21 femurs and seven tibias and conventional intramedullary nails in 16 femurs and 20 tibias. Fracture union was obtained in 34 of the 38 femoral infected pseudarthrosis (89.5%) and 19 of 27 tibial infected nonunions (62.5%) following interlocking nailing. Seven of the eight failures (87.5%) in the tibial group were the result of reoperation with interlocking nails following infected plate fixation. Following removal of the interlocking nail and treatment of residual infection, osteomyelitis was considered quiescent in 59 patients (35 femurs and 24 tibias) and active in five patients (two femurs and three tibias). Today, external fixation in combination with gentamicin-PMMA chains for local antibiotic treatment is used in the majority of such cases, because fracture instability and the chronic osteomyelitis can be treated simultaneously.

Adult↗

PubMedDate not supplied

Severe complication of surgical treatment of congenital pseudarthrosis of the clavicle.

Congenital pseudarthrosis of the clavicle, as observed in a review of the literature, is a rare condition of uncertain etiology which usually presents on the right side. Four of 10 cases were treated by surgical repair of the pseudarthrosis with excision of the non-union and internal fixation with a Steinmann pin and cancellous bone graft. A major postoperative complication in one case consisted of an acute massive neuropraxia of the brachial plexus (recognized 6 hours postoperatively), and was successfully treated by immediate removal of the internal fixation. Ten months postoperatively, the patient was experiencing only minimal weakness of the right opponens muscle. Roentgenograms at this time showed that the pseudarthrosis had healed but with angulation of the clavicle.

Child↗

PubMedDate not supplied

Detection of synovial pseudarthrosis by 99mTc scintigraphy: application to treatment of traumatic nonunion with constant direct current.

A prospective study utilizing technetium scintigraphy to evaluate nonunion patients prior to the electrical stimulation of osteogenesis is reported. Roentgenographic evaluation and scintigraphy must include four views (anteroposterior, lateral and both obliques). Although all nonunion technetium scans showed increased uptake of the radionuclide at the fracture site, three bone scan patterns were identified: (1) intense, uniformly increased uptake at the nonunion site (69.5%); (2) photon deficient (cold) cleft between two intense areas of uptake (23.4%); and (3) indeterminate pattern (7.1%). The presence of a cold cleft between two intense areas of uptake on scintigraphy correlated closely with the presence of a synovial pseudarthrosis at surgery. Nonunions of the humerus were most frequently associated with synovial pseudarthrosis (57.1%). The presence of a synovial pseudarthrosis as suggested by technetium scintigraphy mandates open excision of the lining membrane at the time of electrode insertion.

Diphosphonates↗

PubMed1982

Congenital pseudarthrosis of the tibia. A long-term follow-up study.

A review of 36 cases of congenital pseudarthrosis of the tibia revealed that at long-term follow-up, patients tended to fall into three groups: (1) those who show the typical radiographic and physical findings of congenital pseudarthrosis of the tibia, fracture before eight years of age and progress of pseudarthrosis; these cases tended to proceed to a poor end-result, regardless of the form of treatment; (2) those who did not show the typical prefracture stage but fractured after the eight years of age responded well to grafting procedures and had minimal shortening and satisfactory results at long-term follow-up; and (3) those patients who presented with a prefracture stage tibia but were braced and never fractured, and had a satisfactory end-result.

Adolescent↗

PubMedDate not supplied

Surgical and electrical methods in the treatment of congenital and posttraumatic pseudarthrosis of the tibia.

This is a report of two adult patients with posttraumatic and seven children with congenital pseudarthroses treated by surgical and electrical methods. Interest was focused primarily on congenital pseudarthroses because of the unquestionable severity of these cases and consequently a very high benefit/risk ratio. Three procedures were used: external (Hoffmann) fixation combined with monophasic or biphasic pulsed current stimulation; internal (transtarsal) fixation combined with pulsed electromagnetic field stimulation; and surgical treatment only, as above, without electrostimulation. Healing was achieved in both treated cases of posttraumatic pseudarthrosis and in nine of 14 instances in cases of congenital pseudarthrosis stimulated electrically, as well as in two instances with no electrostimulation. In seven instances, the bone remained healed for nine months or more, the longest period being almost 5.5 years. Both pulsed current and electromagnetic field stimulation seem to enhance the process of bone healing. However, comparison between the different stimulation methods cannot be made on the basis of the limited material presented here, and the need for more basic studies still exists. Concerning the surgical treatment, it seems that transtarsal fixation is a better choice for congenital pseudarthrosis than fixation with an AO-plate, Rush pin or Hoffmann apparatus.

Adolescent↗

PubMed1982

Amputation for congenital pseudarthrosis of the tibia. Indications and techniques.

The indications for amputation with pseudarthrosis of the tibia are: failure of bony union after three surgical attempts; significant leg-length discrepancy; interference with growth distal to the pseudarthrosis; and a significant period under medical care, such that the patient suffers unduly. The primary problems related to amputating at the level of the pseudarthrosis are poor stump configuration, bony overgrowth, and poor skin coverage. A distal amputation at the ankle is recommended, using the technique for a cartilage-preserving Symes amputation. Methods for realigning the tibia at the time of amputation include the use of an intermedullary rod or a compression plate. The ultimate goal of treatment is always a functional limb.

Amputation, Surgical↗

PubMed1995

Follicular atrophoderma in association with congenital pseudarthrosis of the tibia.

Follicular atrophoderma has always been associated with other congenital malformations including, Conradi-Hünermann syndrome, Bazex's syndrome and keratosis palmaris et plantaris dissipata. Congenital pseudarthrosis of the tibia has usually been associated with neurofibromatosis. We report a case of follicular atrophoderma in association with congenital pseudarthrosis of the tibia: a previously unreported association with, in our case, a good outcome for the pseudarthrosis.

Adolescent↗