Non-accrete fractures or nonunion — treatment pseudoarthrosis

Nonunion as a complication after a fracture

False joint after fracture – breaking of bone with the advent of mobility in her unusual parts.

Nonunion occurs after 3% of fractures often occurs after fracture of the femoral neck , radius, innate — to the Shin.

Accounting for 0.5% of all congenital lesions of the locomotor system.

Classification pathology

Originally isolated:

  • acquired;
  • innate.

Mind:

  • fibrous without loss of bone substance;
  • true;
  • lesions with loss of bone substance.

According to the method of formation:

  • normal scars;
  • atrophic;
  • hypertrophic.

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Than can be caused by the phenomenon

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Common causes:

  • congenital abnormalities of bone development;
  • osteoporosis;
  • injury;
  • cancer;
  • endocrine problems;
  • improper diet;
  • intoxication;
  • rickets;
  • pregnancy.

Local causes:

  • errors during surgery;
  • illiterate in plaster;
  • early removal of a cast;
  • incorrectly implemented change of plaster;
  • the displacement of bone in a cast;
  • early load on the limb;
  • contamination of the wound.

Non-accrete fractures and pseudoarthrosis are also often coexist with each other.

That indicates pathology

The clinical picture of the disorders is always visually expressed.

The most frequent place of occurrence of this deviation is concentrated in the region of the ankle, so the eye catches the curvature arising from the development of a false joint.

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If the injured leg to load, then the site of the lesion it will podvorachivaetsya, because the muscles of this leg is extremely weak.

Main features:

  • pain at the injury site during the treatment period;
  • deformation in the affected area;
  • unhealthy mobility;
  • violation of support and gait;
  • a decrease in muscle tone of the limb;
  • the mobility in the joints above and below injury restricted;
  • the swollen parts of the limb below the fracture;
  • the x-rays — a clear fracture line, displacement.

Diagnosis

The diagnosis is a trauma surgeon on the basis of anamnesis, clinical picture, time last from the moment damage. If passed, the average time required for fracture healing, then this is evidence of a slow recovery.

In the case when the term fusion has been exceeded several times, diagnosed with pseudoarthrosis.

This division of medicine is conditional, but is of great importance in the choice of treatment algorithm. If you have a slow fusion will have a chance for fusion. Upon the occurrence of a false joint independent recovery is not possible.

The main method of diagnosis — x-ray.

On the x-ray determined hypertrophic and atrophic pseudarthrosis:

  1. Hypertrophic pseudarthrosis characteristic of the active growth of bone tissue at the site of injury. On the x — ray extension ends of fragments.
  2. In atrophic lesions visible boundaries of the ends of the bones fracture. The Central part of it may not be a boundary if formed a rough scar, but the edges of the fracture line clearly visible.

Treatments

There are conservative ways (drug delivery, electrical stimulation, etc.), but the main treatment is surgery — compression osteosynthesis.

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Principles of surgical treatment:

  • is 6-12 months. after wound healing;
  • scars should be to remove them and perform skin plasty, this is not a neocolony osteosynthesis;
  • fragments are required to match;
  • the refreshment of the ends of the bones, repair and scar removal.
  • the most used interventions:
  • intervention by the principle of «Russian castle»;
  • osteosynthesis transplants;
  • operation Chaklin.

With the defeat of the use of Ilizarov, she, etc.

When you combine the quality of the connection of bone fragments, holding on through the apparatus and plasty of bone significantly improve treatment outcomes.

With the defeat of the tibia osteosynthesis makes it possible to achieve fusion without surgery, to neutralize the inflammation. The term of the limb in the apparatus and adhesions to 8 months. Loading the limb is possible after 2 months. after the procedure.

Serious problems are observed in the treatment of disorders with loss of bone tissue, caused by open fractures, radical surgical treatment of the bone wound when removed large areas of the bone. In this situation, the x-ray visible large bone defect.

Treatment then often surgical. If there is no need to wear orthoses.

When «loose» joints used plastic and plastic by-pass the bone, with the defeat of the tibia — surgery Ghana-Huntington.

One of the conditions of fusion — the strength of the connection of fragments.

The neglect of this rule — the cause of the recurrence of the disease, and requires a new operation.

Is it possible to prevent deviation?

Prevention of congenital false joint does not exist.

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And prevention of acquired defects — adequate treatment of fractures, high-quality immobilization of the patient’s body.

People often asked early to remove the cast because nothing hurts, need to go somewhere or to work. You can not do that, because if you remove the cast before, at the site of injury will occur about the joint.

To prevent the development of this deviation, the consequence of which is disability, and the treatment may require multiple operations, should adhere to all medical regulations and after removal of plaster to use elastic bandage.