Treatment Of Pseudarthroses Research Articles

Use of autocompression plates in the treatment of pseudarthroses

Report about the results of surgical treatment of 115 pseudarthroses of the long shaft bones treated by means of autocompression plates (ACP) in about 2/3 of the cases an additional autogenous bone plasty was performed. A follow-up examination was possible in 113 cases (98.25%). At all a solid consolidation could be achieved in 93.0%, even in difficult primary situations, including defect pseudarthroses and also infections. In 86.1% the healing occurred after the first surgery, in the remaining cases revisions were needed. Complications were very rare. In 3.5% arthrodesis or joint replacement of the involved joint was performed. Finally only 1.75% persisted in pseudarthrosis.

Infekt-/Defektpseudarthrose

Treatment of pseudarthroses with bony defects of long bones is one of the most difficult tasks in modern trauma surgery. Several problems have to be treated either at the same time or in order of priority. Infection, bone instability and secondary bone regeneration always mean the patient will be subjected to several operations. The level of compliance that can be expected from the patient also has to be considered when the individual treatment strategy is elaborated. These cases should be treated only in trauma level I centers where the surgeons are familiar with all modern procedures of reconstructive surgery and are available round the clock. The results obtained in the specialist centers are extremely promising, but the patient is still always left with lasting sequelae. Every effort must be made to prevent these from developing, though this will not always be possible. In future, the insurance companies should demand better control of the treatment with earlier referral to specialist centers to spare patients very long courses of treatment and healing with a bony defect. The increasing pressure to reduce costs could turn out to be an opportunity for improvements, but only if the specialist centers receive appropriate remuneration.

Extracorporeal Shock Wave Application in the Treatment of Pseudarthrosis

Approximately 5% of all bone fractures are complicated by the development of a pseudarthrosis, i. e., a delay in fracture healing of more than 6 months. Pseudarthroses can be caused by several reasons, such as inappropriate vascular supply, improper immobilization, or a large distance between the ends of the bone fragments. In cases of aseptic pseudarthroses, surgical intervention is the current state-of-the-art therapy, with the aim of healing the pseudarthrosis itself and correcting false positions of bone fragments and differences in the lengths of the extremities. About 10 years ago, extracorporeal shock wave administration was introduced into the treatment of pseudarthroses. Interestingly, the current use of extracorporeal shock waves with high energy in the treatment of pseudarthroses is based on the unproven assumption that the induction of microfissures and bone fragments is necessary for healing. Furthermore, the studies published so far are very heterogeneous with respect to inclusion and exclusion criteria of the patients, type and localization of the pseudarthroses, therapeutic design, and follow-up strategies. Based on the results of these studies, which are critically reviewed here, one can conclude the following: (I) hypertrophic pseudarthroses seem to be better targets for extracorporeal shock wave application than atrophic ones (II) altogether, treatment of pseudarthroses with extracorporeal shock waves results in rates of bony union of approximately 75%, but the real value of this data is yet to be confirmed by controlled prospective studies (III) the clinical studies carried out so far do not seem to set the proper framework for randomized, placebo-controlled studies.

Posttraumatic pseudarthroses--an analysis of development and treatment.

The results of the analysis of 339 pseudarthroses in 326 patients are reported. We reviewed the aetiology and previous therapy of patients with pseudarthroses, their X-ray, case reports and assessed them clinically. We noticed instability as an important aetiological factor for development of non union, especially in combination with a bone infection. The evidence of failures due to a inadequate implant or due to an inadequate surgical technique is shown. Further aetiological factors are discussed. Our principles of treatment of pseudarthroses are outlined. The first principle is to achieve stability by operative procedure. The second is to indicate correctly bone grafting. The third principle concerns infected non unions in which extensive surgical revision is necessary. By carrying out this therapy we achieved bone healing in 95.4% of non infected pseudarthroses and in 86.8% of infected pseudarthroses.

Treatment of Pseudarthroses with Electrodynamic Potentials of Low Frequency Range

In 319 patients suffering from septic and noninfected pseudarthroses, bone consolidation has been achieved in 93.6% by a cancellous bone graft plus a semi-invasive method of electrostimulation of nonunion using low frequency A.C. potentials, i.e., the electrodynamic procedure. By inductively coupled electromagnetic fields, the potentials are produced in inductable implants. There are no contraindications for the procedure and no side effects.

Electrical stimulation of the callus formation by means of bipolar rectangular pulse sequences

The clinical application of the electrical stimulation, lasting several weeks, for the callus formation is reported in 11 patients. Bipolar rectangular pulse sequences were used for the stimulation at a frequency of 1 Hz and a current intensity of +/-20mu amp. The electrical stimulation was successfully employed after distraction osteotomies with a KDA-apparatus in shortening of the leg provoked by different causes or in the treatment of pseudarthroses. The realignment of the newly formed callus and the osseous consolidation are stimulated and speeded up by the bipolar rectangular pulse sequences as it is also shown in the light of the roentgenograms of a case.

Contribution to the Treatment of Pseudarthroses of the Forearm

Contribution to the Treatment of Pseudarthroses of the Forearm

Contribution to the Treatment of Pseudarthroses of the Forearm

Contribution to the Treatment of Pseudarthroses of the Forearm