Treatment Of Pseudoarthrosis Research Articles

Is Using a Ring External Fixator in the Treatment of Congenital Pseudarthrosis of the Tibia Associated With Better Results or Using a Locking Plate?

Congenital pseudarthrosis of the tibia (CPT) is a rare disease. CPT is often unilateral and occurs between the middle and distal third of the tibia. Concurrent involvement of the fibula is present in more than half of cases. histologic studies indicate the presence of fibrous hamartoma tissue and a sick periosteum, which leads to recalcitrant bone fracture and, eventually, pseudoarthrosis. Although there are various surgical techniques, we intend to compare the 2 methods of external fixation versus internal plating. Demographic data were collected from 26 patients with frank pseudoarthrosis. After exclusion criteria, patients were compared in groups A (12 patients) and B (11 patients). Resection of hamartoma and sclerotic bone, intramedullary rodding and autologous bone, and periosteal grafting were performed for all patients. In group A, we used a ring external fixator for compression and rotational stability, but in group B, a locking plate was used for these purposes. Plating takes less time to use during surgery. In group A, the primary bony union was obtained in 67% of patients, while in group B, 82% of patients had a primary union. Meanwhile, the average time till the final union in group A was 6 months, while in group B, this time was 3.5 months. Positive union mass was obtained in 58% of the patients in group A and 82% of group B. In addition, plating prevented ankle valgus deformity in group B. Permanent intramedullary rodding is a surgical requirement for correction of deformity and refracture prevention, but additional stability can be achieved with the use of a ring external fixator or internal plate. Cross union and positive union mass are 2 important factors in the treatment of pseudoarthrosis; these results are achieved to a greater extent and in a shorter period of time using the plate. level IV - case series.

Clinical Results of Decortication with Bone Grafting Method versus Extracorporeal Shock Wave Treatment in Long-Bone Pseudoarthrosis.

BACKGROUND Despite advanced treatment methods, the treatment of pseudoarthrosis still poses a significant challenge for orthopedists. In this study, we aimed to assess the clinical results of decortication and bone grafting and extracorporeal shock wave treatment (ESWT) in long-bone pseudoarthrosis. MATERIAL AND METHODS Between 2007 and 2015, 68 fractures of 66 patients treated for long-bone pseudoarthrosis were evaluated retrospectively. ESWT was used in 36 extremities and decortication and iliac bone grafting was used in 32. The treatment results of these patients were evaluated and compared with rates in the literature. RESULTS The mean patient age was 43.9 years (range, 21-69). The mean interval between the occurrence of the fracture and treatment with bone grafting or ESWT was 8.6 months and the mean interval between the procedure and achievement of union was 6.9 months. The patients were followed up for a mean period of 25.2 months. After the mean follow-up period, bone union had occurred in all 32 patients (100%) in the decortication and bone grafting group and in 28 (78%) of the 36 patients in the ESWT group (P=0.023). CONCLUSIONS This study shows that extracorporeal shock wave treatment should be considered the first option in treatment of pseudoarthrosis as it is a non-invasive method and also provides good rates of union. In patients that do not heal with ESWT, decortication and bone grafting remains the criterion standard therapy.

Combined Transosseous Osteosynthesis of Fracture of Humerus Diaphysis in Case of Reparative Process Disorder (Clinical Observation)

The treatment of the consequences of diaphyseal fractures of the humerus, despite the emergence of modern effective methods of internal osteosynthesis, has not lost its relevance. Transosseous osteosynthesis remains the method of choice in the treatment of pseudoarthrosis and delayed consolidating fractures of the humerus. The experience we have accumulated in the use of external fixation devices in the treatment of fractures, based on the use of the method of unified designation of transosseous osteosynthesis, made it possible to systematize and describe the surgical technique of combined transosseous osteosynthesis in the treatment of fractures of the humerus diaphysis with impaired reparative processes in combination with longitudinal corticotomy of the pseudarthrosis zone, and evaluate its effectiveness. The article presents a case of successful surgical treatment of a patient with a pseudarthrosis of the humerus diaphysis by the method of combined transosseous osteosynthesis in combination with longitudinal corticotomy of the pseudarthrosis zone. A description of the technique of transosseous osteosynthesis is given. The presented clinical case shows that the use of combined transosseous osteosynthesis, taking into account the method of unified designation of transosseous osteosynthesis, makes it possible not only to determine the optimal arrangement of the apparatus and the positions of the transosseous elements, but also to use this method to determine the optimal area for performing longitudinal corticotomy.

Radial Shock Waves in the Treatment of Pseudoarthrosis

Thirty-eight patients who were scheduled for unilateral total knee arthroplasty were examined by dual-energy X-ray absorptiometry. Measurements of the contralateral knee and both hips were performed within a week of the operation then 1, 2 and 4 years postoperatively. The clinical status of the operated knee was recorded preoperatively and at each follow-up visit.

Aseptic Pseudoarthrosis of Olecranon: Epidemiological Features and Therapeutic Assessment

Introduction: Pseudoarthrosis is one of the most dreadful complications of olecranon fractures. It seriously compromises the function of the elbow. Objectives: To determine the epidemiological factors of this complication in order to prevent them and to assess the results of the therapeutic management. Material and method: This was a retrospective study that involved patients with olecranon pseudoarthrosis who were treated in the department between January 2006 and December 2016. The diagnosis of pseudoarthrosis was made at least 6 months after the management of the fracture. There were 16 men and 5 women. We analyzed the epidemiological factors, the treatment of pseudoarthrosis, and the postoperative outcome. Results: The incriminated factors were the complexity of the fracture line and the quality of treatment of the recent fracture. The osteosynthesis of pseudoarthrosis is similar to that of recent fractures. It requires in some cases a bone graft. The results of the treatment are satisfactory with 100% of consolidation, and a good functional result in 75% of the cases. Conclusion: The treatment of olecranon pseudoarthrosis is based above all on prevention by an optimal management of the recent fractures. The curative treatment gives satisfactory functional results.

Surgical treatment of pseudoarthrosis of lateral humeral condyle of humerus with cubitus valgus in children

Surgical treatment of pseudoarthrosis of lateral humeral condyle of humerus with cubitus valgus in children

Treatment of pseudoarthrosis after minimally invasive hallux valgus correction.

Objective:Treatment of mild and moderate hallux valgus deformities.Discussion:Minimally invasive technique enables surgeons to treat mild and moderate hallux valgus deformities with excellent and good results in the majority of patients. Nonunion of first metatarsal, moreover, has only rarely been reported.Summary:We describe the essential steps of a surgical technique for the treatment of nonunions after miniinvasive subcapital first metatarsal osteotomy reconstructed using a tricortical iliac crest bone graft.

견봉 골절의 불유합으로 기인한 가관절증의 잠김 금속판을 이용한 치료 - 증례보고 -

A painful pseudoarthrosis will develop due to a delay in diagnosis and treatment, and surgical care is required. Treatment of pseudoarthrosis is really difficult because the acromion is a thin flat bone that is difficult to be fixed firmly. A 52-year-old woman with multiple trauma had an acromial fracture that was not detected until it had caused pain after ambulation. Open reduction and internal fixation with a variable angle locking compression plate for distal radius and autogenous iliac bone graft were performed. At nine months after the operation, there was partial tear in the supraspinatus tendon, and arthroscopic repair of the supraspinatus tendon was performed. At nine months after the operation, radiographs showed a complete union. At three months after tendon repair, the patient had excellent function of the shoulder. We have reported a case of a successful treatment of nonunion and pseudoarthrosis of acromial fracture that is difficult to be fixed.

Plasma rico em plaquetas para consolidação de ossos longos

ABSTRACTObjective:To evaluate effectiveness of the use of platelet-rich plasma as coadjuvant for union of long bones.Methods:The search strategy included the Cochrane Library (via Central) and MEDLINE (via PubMed). There were no limits as to language or publication media. The latest search strategy was conducted in December 2011. It included randomized clinical trials that evaluated the use of platelet-rich plasma as coadjuvant medication to accelerate union of long bones (acute fractures, pseudoarthrosis and bone defects). The outcomes of interest for this review include bone regeneration, adverse events, costs, pain, and quality of life. The authors selected eligible studies, evaluated the methodological quality, and extracted the data. It was not possible to perform quantitative analysis of the grouped studies (meta-analyses).Results:Two randomized prospective clinical trials were included, with a total of 148 participants. One of them compared recombinant human morphogenic bone protein-7 versus platelet-rich plasma for the treatment of pseudoarthrosis; the other evaluated the effects of three coadjuvant treatments for union of valgising tibial osteotomies (platelet-rich plasma, platelet-rich plasma plus bone marrow stromal cells, and no coadjuvant treatment). Both had low statistical power and moderate to high risk of bias.Conclusion:There was no conclusive evidence that sustained the use of platelet-rich plasma as a coadjuvant to aid bone regeneration of fractures, pseudoarthrosis, or bone defects.

Cell Therapy in Patients With Pseudoarthrosis: Cost Analysis and Consequences

The treatment of pseudoarthrosis is often long and with great financial and social cost. The aim of this study was to analyze the costs and consequences of stem cells application in patients with pseudoarthrosis. Methodology: This study is an economic analysis of costs and consequences. It was undertaken in a University Hospital from September 2008 to December 2010. The direct costs and time to fracture healing of eight patients were raised. Results: The follow up of patients after the procedure was for six months. From eight patients, seven were healed. The healing time was an average of 14.7 weeks. The direct costs of hospital treatment was R$ 1,207.75. Conclusion: The results of this study are encouraging. The future challenge will be to increase the sample and evaluate the effectiveness of this procedure. Descriptors: Cost; Consequence Analysis; Economics, Nursing. Received: 09/20/2011 Approved: 04/19/2012

Extracorporeal shock-wave therapy in the treatment of pseudoarthrosis: a case report

We describe the case of a of a 23 year old man (european) with a complicated fibular-tibial shaft fracture with subsequent pseudoarthrosis formation, which was unable to be corrected by surgery, but which we were finally able to heal using Extracorporeal shock-wave therapy.

Extracorporeal shockwave therapy - successful alternative in orthopedic treatment

Extracorporeal Shockwave Therapy ( ESWT, Orthotripsy) has increasing popularity in treatment of various orthopaedic conditions, like delayed and noneunion of bones( pseudoarthrosis), shoulder periarthritis, plantar fasciitis and calcaneal spur, tendopaties - tennis or golfer elbow. The study aims to present successful results after application of ESWT in 204 patients for 5 years period, using two popular shock wave devices. The results are promising and are quite near to these after surgery. There is success in treatment of pseudoarthrosis in 64% of patients. Shoulder pain is reduced in 75% of patients with shoulder periarthritis and their calcificates are altered in 68%. The plantar fasciitis and epicondilitis complaints are successfully treated in 71% and 69% respectively. ESWT demonstrate results that are comparable to those after surgery. The advantages of the methods like low patients morbidity, no risks or any side effects, quick recovery, make Orthotripsy preferable method in orthopedic practice. Scripta Scientifica Medica 2008;40(1):63-66

Vascularized bone grafts in the treatment of pseudoarthrosis with large bone defect and infection and osteomyelitis

Vascularized bone grafts in the treatment of pseudoarthrosis with large bone defect and infection and osteomyelitis

Treatment of Pseudoarthrosis Using Tissue-Engineered Bone Graft

Subjects were graft patients with pseudoarthrosis (average age, 60.3 years; range, 17-85 years). Pseudoarthrosis affected the thoracolumbar spine, the femur, the clavicle, the humerus and the metatarsal. From the ilium (tibia in one patient), 10-20 ml of bone marrow fluid was collected, and then, it was immediately transferred to the culture room and incubated in a flask containing MEM with 15% autologous or fetal bovine serum, etc.. After 2 weeks in primary culture, cells were released by trypsin treatment and were subsequently incubated with porous beta-TCP in order to prepare tissue-engineered artificial bone, according to the previously reported modified culturing technique. Tissue-engineered artificial bone was grafted around the non-union site of each affected long bone, while tissue-engineered artificial bone was grafted via the pedicle of each affected vertebral body. In all patients, favorable bone formation was seen at three months after surgery. In the patients with pseudoarthrosis of the spine, CT and MRI confirmed favorable vertebral body formation. In the patients with pseudoarthrosis of a long bone, the artificial bone was remodeled and favorable bone union was confirmed. In 2 patients in whom bone biopsy was performed during pin removal, bone regeneration was confirmed histologically. With present type of tissue-engineered artificial bone, an artificial material with a high bone regeneration capacity can be prepared by aspiration, which is minimally invasive, and thus when compared to iliac bone grafts, it is possible to radically reduce postoperative pain without damage of autologous bone.

Treatment of Pseudoarthrosis of Navicular Bone Using External Fixation

Treatment technique for navicular pseudoarthrosis using extrafocal constant longitudinal distraction with external anchor-pin device is suggested. That device was fixed on radius and 2nd metacarpal bone. Traction precisely oriented on navicular provided the decompression of wrist joint, improved the microcirculation in injured joint and promoted consolidation of navicular bone at the optimum terms. In 18 patients, aged 21-50, efficacy of that treatment was shown at 2 years follow up.

Simultaneous treatment of pseudoarthrosis of mandibular body fractures and inferior alveolar nerve defects

The purpose of this paper is to present the experience with two patients with pseudoarthrosis of mandibular body fractures and unacceptable anesthesia of the lower lip and chin on the affected side. This was corrected by establishing stable fixation with locking screw mandibular plate, microsurgical repair of the inferior alveolar nerve, and filling the fracture gap with an autogeneous bone graft. The combination of these therapies resulted in satisfactory sensory improvement without complications in both patients.

Treatment of pseudoarthrosis of the distal phalanx with the palmar midline approach

Treatment of pseudoarthrosis of the distal phalanx with the palmar midline approach

Pseudoarthrosis of a Fracture of the Acromion

Fractures of the acromion are rare. Conservative therapy in the majority of cases results in return to full function of the shoulder. Occasionally, however, a painful pseudoarthrosis will develop and surgical care is required. The American literature reports several cases of acromial fracture but has not specifically addressed the treatment of pseudoarthrosis with open reduction and internal fixation. We report such a case and review the American and European literature.

Treatment of pseudo-arthrosis of the mandibular body by a sliding bone graft

Treatment of pseudo-arthrosis of the mandibular body by a sliding bone graft

On Osteosynthesis in the Treatment of Pseudoarthrosis of the Femoral Neck

On Osteosynthesis in the Treatment of Pseudoarthrosis of the Femoral Neck