Diagnostics

In addition to physical examination, imaging diagnostics offers the greatest degree of certainty for the diagnosis of pseudoarthrosis. In most cases, a simple x-ray of the affected area is made. In the case of pseudoarthrosis, this would show any remaining fracture gap and, if necessary, axial deviations of the bone. In addition, cysts can be made visible in this way: the lack of healing causes the bone to react with excessive, undirected bone formation, which can be seen in the X-ray image in the form of so-called gravel cysts at the edges. If pseudarthrosis cannot be confirmed in an x-ray, it is still possible to make a magnetic resonance tomography, which shows an even more detailed image of the bone and the surrounding soft tissue.

Therapy

Every fracture of the femur is usually operated on and corrected by means of osteosynthesis (i.e. using plates, screws or nails). A reduced blood flow or infectious pseudarthrosis are possible complications of this surgical procedure. As a result, atrophic pseudarthrosis develops and the defective femur cannot heal completely.

The treatment of this complication consists of another operation (revision surgery), in which the old implant is removed and the fracture site is thoroughly cleaned. Excess scar tissue or necrotic material is cut out and the fracture site is treated with an intramedullary nail. In severe and complicated fractures of the tibia, pseudoarthrosis may occur due to impaired blood flow to the bone tissue.

But hypertrophic pseudarthroses also occur when the affected leg is subjected to incorrect mechanical stress. Very rarely a pseudarthrosis is congenital in the tibia, the so-called congential tibial pseudoarthrosis. In this disease the bone metabolism is disturbed and the affected persons suffer from pseudarthrosis in the tibia and fibula already in the first years of life.

The bones in the lower leg continue to bend, resulting in severe malformations. Fractures of the upper arm bone (humerus) can be treated either conventionally (i.e. by resting) or surgically. Problems in therapy, such as a lack of physical protection, incorrect osteosynthesis procedures or the loosening of screws or plates, can lead to the development of pseudarthroses.

Patients report persistent pain that has not improved even weeks after initial treatment of the fracture. Treatment of humerus pseudarthrosis is usually carried out surgically: the fracture is brought together in a stable manner and fixed by means of osteosynthesis. Complicated fractures near the shoulder may have to be treated with a shoulder prosthesis.

In medicine, pseudoarthrosis is a fracture that does not reunite, whereby the two mobile bone fragments form a kind of “false joint” (pseudoarthrosis). The scaphoid bone (Os scaphoideum) belongs to the carpal bones, so a scaphoid fracture accounts for three-quarters of all carpal fractures and occurs, for example, in the context of a fall on the overstretched (dorsally extended) wrist. If a scaphoid fracture is overlooked or not adequately treated, pseudoarthrosis can occur.

In this case, the bone parts no longer grow together firmly and small movements are possible between the fragments. The result is collapse of the carpus with subsequent incorrect loading and arthrosis of the hand. Many affected persons feel only moderate load-dependent pain, which is located on the thumb side of the wrist.

A reduction in strength may also occur. A two-plane x-ray is a groundbreaking diagnostic tool in the diagnosis of scaphoid pseudoarthrosis. Since in many cases a pseudoarthrosis is not visible here, a further image is taken according to Stecher, in which the hand is clenched to the fist and abducted towards the ulnar (towards the little finger).

A computer tomographic image of the scaphoid is taken for planning the operation or for a more precise assessment. It is crucial that the examination is performed through the longitudinal axis of the scaphoid in order to obtain the most accurate possible information about the malposition, the size of the defect and the location of the pseudoarthrosis. In the case of older pseudoarthroses and a strong suspicion of insufficient or no blood supply to the bone parts, magnetic resonance imaging of the hand (MRI of the hand) with contrast medium is the appropriate procedure to assess the blood supply.

Even if the affected person has only minor pain or discomfort due to the pseudoarthrosis, the scaphoid pseudoarthrosis should always be stabilized surgically. The main focus here is on avoiding long-term damage resulting from incorrect loading, such as arthrosis. The operation achieves a bony reunion of the fragments and the restoration of the original scaphoid shape.

In most cases, the defect must be filled with functional bone material from the iliac crest or radius. If the remaining bone fragment is not sufficiently supplied with blood vessels (vascularized), microsurgical techniques are used to remove the bone block to be transplanted, including the vascular style, and transplant it into the scaphoid. The operation is usually associated with an inpatient hospital stay of about three days, followed by a four to six-week immobilization in a plaster cast.

A bony development of the scaphoid should then be visible in the X-ray image after three months.After a broken rib (fracture), insufficient healing can lead to so-called pseudoarthrosis. The bone fragments that have not grown together are mobile and thus form a “false joint”. The most common cause for the failure of the bone fragments to grow together is insufficient blood circulation.

Incorrect behavior after a bone fracture or an operation, such as loading too quickly and a too short rest period for the patient, can also be a reason for the development of pseudoarthrosis. Risk factors are beside the point: The symptoms of pseudoarthrosis, like the disease itself, often appear only gradually. These include redness, swelling and pain, which mainly occur when coughing or sneezing, and then also at rest.

Furthermore, bone stability can be greatly reduced, this axial deviation can also be visible from the outside. Conservative treatment methods for pseudoarthrosis, such as immobilization with a plaster cast, are difficult to manage in cases of pseudoarthrosis of the ribs. If the affected person feels pain and a restriction of mobility, the pseudoarthrosis can be treated surgically.

A relatively new, non-invasive procedure is a low-frequency ultrasound treatment that is applied daily over a period of several months and is intended to stimulate bone growth even in older pseudoarthroses. The success of the treatment is regularly recorded by the treating physician with x-rays.

An unhealthy way of life
Excessive consumption of alcohol
Smoking
Diabetes mellitus.

Fractures of the collarbone (clavicle) are usually treated conservatively.

In the case of the clavicle, this usually means a backpack bandage, which is left in place for 3 – 4 weeks. In about 2 – 6% of cases, this can lead to the development of pseudarthrosis. In surgical procedures, the rate of pseudoarthrosis is even somewhat higher (which is usually due to more complicated fractures that make surgery necessary in the first place).

Every year, 4,000 – 8,000 patients are affected by this clinical picture in Germany alone. As a result, pain and a reduction in the function of the shoulder are very common complaints. Factors that increase the risk of developing pseudoarthrosis of the clavicle are mainly complicated fractures, infections and inadequate surgical treatment.

Whether and how a pseudoarthrosis of the clavicle needs to be treated depends primarily on whether the patient has any complaints at all. If the pseudoarthrosis is asymptomatic, i.e. does not cause any complaints of any kind, it can remain untreated or be treated conservatively. If this is not the case, surgery is indicated.

The fracture ends are usually connected with metal plates and screws. Another surgical procedure that can be used is intramedullary fixation, e.g. the use of a nail located in the bone marrow. If this is possible, there are several advantages (including cosmetic), such as a smaller operation scar.

In most cases, the implants are finally removed a few months to 2 years after the operation. Nevertheless, even after successful surgery and good healing of the injury, many patients still complain of discomfort, especially pain when moving the shoulder. The reasons for the development of pseudarthrosis of the foot are similar to those of other bones.

Inadequate or late treatment of the fracture is a common cause for the development of a false joint, as is too early loading of the injured foot. The probability of developing pseudoarthrosis is particularly high in the case of the so-called Jones fracture; especially if the therapy is conservative, for example with the help of a plaster cast. The Jones fracture is a fracture of the 5th metatarsal bone close to the base, i.e. a fracture at the end of the metatarsal bone of the outer edge of the foot directed towards the heel.

Pseudoarthrosis is characterized by pain when walking and abnormal mobility of the affected bone. In order for the fracture to heal completely, it must be compressed with a screw or a tension strap. It may be necessary to introduce bone material from the iliac crest to achieve acceptable healing of the fracture.

In any case, an injury to the tarsometatarsal joint (the joint between the tarsus and the metatarsal bone) must be ruled out by x-ray during the course of treatment. Pseudoarthroses of the spinal column in general usually occur during surgery or as a result of fractures of the vertebral bodies.As a result, false joints develop, which, unlike real joints, are not covered with cartilage. Severe pain, especially during movement, as well as increased mobility and instability are the consequence. Surgery is usually the only treatment option that allows the two fragments to fuse together properly.