Pseudoarthrosis
What’s that?
False joint (pseudoarthrosis) is a nonunion of bone fragments, as a result of which they retain pathologic mobility.
About the disease
False joints and defects of the articular ends of limbs as an unfavorable outcome of fractures of long tubular bones are not rare and are observed in some situations after reconstructive surgeries. Commonly accepted forms of false joints and bone part defects are fibrous pseudoarthrosis (bone ends connected by loose connective tissue), neoarthrosis (pathologic joint with synovial sheath), true bone part defect, and articular end defect.
The diagnosis is made based on radiologic scanning data. The main method of treatment is surgical intervention. The general principles of surgery are partial removal of the formed pathologic tissue and subsequent fixation of bone fragments using titanium constructs.
Types of pseudoarthrosis
According to etiology, two types of false joints are distinguished:
- congenital – nonunion of bone segments is associated with ossification disorders at the intrauterine stage of the child’s development;
- acquired – is the result of traumatic injury to the bone, in which bone regeneration is impaired.
According to the topographic-anatomical classification, false joints of the following localization are distinguished:
- shoulder girdle and arm – pseudoarthrosis of the clavicle, humerus, forearm (radius and ulna), hand (including navicular bone, phalanges of fingers);
- lower extremity – false fusion is formed in the femoral neck, femur, tibia (tibia and fibula, including ankle projection), foot (with tarsal, metatarsal, and phalangeal bones affected)
- maxillofacial region – mandible;
- torso – false rib joints.
Symptoms of pseudoarthrosis
The main symptom of a false joint is the persistence of unnatural mobility at the fracture site. Because of this, the functional state of the injured area is disturbed. Thus, a person cannot wholly lean on the leg and walk freely. With pseudoarthrosis of the hand, the holding of objects and the performance of manual work are disturbed. There is no pain during palpation. Pain and discomfort appear with an axial load on the limb.
In congenital pseudarthrosis, the unnatural movement is slightly higher than the acquired form.
Causes of a false joint
The causes of a false joint are most often due to impaired bone fusion after a fracture. It can be due to the following factors:
- insufficient intake of vitamin D and calcium;
- concomitant diseases of the kidneys, glands of internal secretion, liver;
- multiple fractures;
- unfavorable background in the form of osteoporosis.
Diagnosis
The diagnosis is made based on radiologic scans. On X-ray images, a zone of bony nonunion is clearly visible in most cases as a dark band between lighter-colored bone segments. It is the main sign of pseudarthrosis. In complex clinical cases, a CT or MRI scan is indicated.
Treatment of a false joint
The main method of treatment for a false joint is surgery.
Conservative treatment
Conservative therapy of a false joint is ineffective. The bone tissue on the fragments becomes callous, and its independent healing (without surgery) becomes impossible. It is necessary to “refresh” the bone ends to stimulate the cell division of osteoclasts.
Surgical treatment
The basic principles of surgical treatment of traumatic and spontaneous fractures resulting in the formation of a false joint are similar and include resection (partial removal) of the bone edges, replacement of the resulting defect with a bone graft, and subsequent fixation of the fragments. Hip arthroplasty is indicated if a false joint is formed in the area of the femoral neck.
The surgery performed for pseudarthrosis is considered adequate if the pain syndrome is eliminated and the physical activity of the person is improved. A set of rehabilitation measures is carried out to improve the effectiveness of surgical intervention.
All these surgical procedures are performed in more than 750 hospitals worldwide (https://doctor.global/results/diseases/pseudoarthrosis). For example, Pseudoarthrosis surgery is done in 2 clinics in Germany for an approximate price of $19.2 K (https://doctor.global/results/europe/germany/all-cities/all-specializations/procedures/pseudoarthrosis-surgery).
Prevention
Prevention of a false joint formation is aimed at timely and proper treatment of fractures. An important role is played by reliable immobilization of bone fragments, which prevents even minor displacement of them relative to each other. The body must have sufficient calcium, vitamin D, and protein for optimal bone tissue regeneration. Usually, only nutrition can meet these needs, so additional vitamin and mineral complexes intake is recommended. In the presence of vitamin D deficiency, confirmed by laboratory tests, appropriate treatment is prescribed. Smoking is also known to impair the body’s ability to heal bones. Nicotine restricts blood flow and decreases oxygen delivery to tissues, hindering the bone’s natural healing process. Therefore, quitting smoking is a crucial step in reducing the risk of pseudoarthrosis. Certain chronic health conditions, such as diabetes, can interfere with bone healing. Individuals with such conditions should work closely with their healthcare providers to manage their conditions effectively and reduce complications during the healing process.
Rehabilitation
After surgical treatment of a false joint, comprehensive rehabilitation is carried out to develop the limb motion. At this stage, physical therapy exercises and massage are prescribed (the load is gradually increased). The active training stage of rehabilitation begins after the formation of bone callus is confirmed by X-ray data.
Conclusion
In conclusion, pseudoarthrosis is a complex medical condition that demands attention and understanding. It arises from a multitude of factors, including inadequate blood supply, infection, and poor immobilization. Recognizing its symptoms and seeking early diagnosis and treatment is crucial for individuals who may be at risk. The treatment options are diverse, ranging from conservative measures to advanced surgical techniques and promising biological enhancements. Furthermore, proactive steps such as following medical advice, quitting smoking, and managing chronic health conditions can reduce the risk of pseudoarthrosis, promoting overall bone health and well-being.
With this comprehensive overview, individuals and healthcare professionals alike can navigate the intricacies of pseudoarthrosis, ensuring prompt and effective management of this challenging condition.
