In medicine, pseudarthrosis is the failure of a bone fracture to heal, from which a false joint develops. It usually causes severe pain and limitations in mobility. Therapy depends on the exact form of pseudarthrosis, and good prognoses can always be given.
What is pseudarthrosis?
The term pseudarthrosis is composed of the Greek words “pseudes” and “arthros” and means something like “false joint”. The terms pseudo joint, pseudo joint, or false joint are used synonymously with pseudarthrosis. The condition is diagnosed when there has been no healing six months after a bone fracture or the surgical procedure of osteotomy. Prior to that, after four to six months without adequate healing, the condition is referred to as delayed fracture healing. The medical profession distinguishes vital pseudarthrosis from avital pseudarthrosis. In the latter, the fracture is unstable, lacks blood supply, and the surrounding tissue is inflamed or dead. In vital pseudarthrosis, there is still good blood supply to the tissue, but the fracture is also unstable.
Causes
The causes of pseudarthrosis are inadequate healing of fractures. Shaft fractures of long long bones, such as the lower and upper legs and the upper and lower arm, are particularly susceptible to pseudarthrosis. False joint also frequently occurs as a complication of a scaphoid fracture. Specifically, mechanical and morbid causes of pseudarthrosis must be distinguished. Mechanical causes include displacement of soft tissues into the fracture region, displacement of the fracture ends against each other, inadequate care of the fracture with insufficient compression of the wound, and mobilization of the fracture too early. Morbid causes include excessive, but incorrect, bone healing, callus, tissue loss due to inadequate patient care or insufficient blood supply to the wound, infections, and systemic diseases. In particular, patients with diabetes mellitus or arterial disease are often affected. Less commonly, the risk of disease is congenital.
Symptoms, complaints, and signs
Pseudoarthrosis can develop when the fracture sites heal inadequately after a bone fracture. In such a case, there is a discontinuity, a disturbance in the healing tissue. Shaft bones such as the femur, ulna, radius and humerus are very susceptible to this. A wide variety of characteristics indicate pseudoarthrosis. If a bone heals relatively slowly after a fracture, this may be the first sign. If healing does not begin within six months, we can speak of pseudoarthrosis. The disease usually develops insidiously. The symptoms are therefore delayed. The first signs of pseudoarthrosis include pain. At the beginning of the disease, this often occurs only under stress. Later, chronic pain may develop at rest. Restrictions in movement and a reduction in strength are also typical of this clinical picture. Conversely, hypermobility and instability can also be signs of pseudoarthrosis. Because the stability of the bone is sometimes greatly reduced, an axial deviation of the bone can develop. This is partially visible. In addition to the symptoms mentioned, redness and swelling in the affected area provide further clues to the development of the disease. Water retention in the area of the bone fracture is not uncommon. In a septic course, systemic symptoms continue to be noticeable. Because pathogens are involved in this development, fever and deterioration of the general condition may occur.
Diagnosis and course
Pseudarthrosis is diagnosed when healing has not occurred six months after the bone fracture. This can and must be determined with imaging techniques. Radiographic diagnosis often reveals pseudarthrosis clefts and sclerosis of the surrounding tissue. Indications of the disease are also persistent movement and functional restrictions or excessive mobility of the affected body parts and persistent pain. It is also important that the diagnosis clearly establishes whether vital or avital pseudarthrosis is present, because therapy is initiated accordingly. The course and prognosis depend on how far the pseudarthrosis has progressed.In the initial stage, there is a good chance of success. But the more the surrounding tissue is affected and the further the hardening has been able to spread, the more difficult the therapy becomes.
Complications
If the doctor’s instructions are strictly followed, the chances of pseudarthrosis healing without follow-up surgery are not bad. For this, a plaster cast must be worn for a full six weeks. If the affected person is diabetic, it is important that he or she is well adjusted to his or her medication or injections in order not to delay healing even further. Smoking is particularly harmful, as every effort should be made to promote good circulation to the affected area. Some patients find it helpful to cool the affected area to reduce pain. Coolers wrapped with a household towel or thin towel can be used for this purpose. Others, suffering from pseudarthrosis, need heat such as cherry pit bags, previously warmed in the oven. The hot water bottles just like the cooling elements thereby never directly on the bare skin put. Most of those affected are nevertheless forced to resort to painkillers in order to get a tolerable grip on the long healing process of pseudarthrosis. What the patient suffering from pseudarthrosis needs above all is patience. The disease is mostly curable, only it would be misleading to orientate on the regular healing process of the preceding bone fracture.
When should you go to the doctor?
If symptoms such as bone pain, malformations of the bones, or movement disorders occur, there may be underlying pseudoarthrosis. A doctor should be consulted when symptoms first appear. If they do not resolve on their own, it is best to consult an orthopedist. The physician can determine the pseudoarthrosis based on an X-ray examination and begin treatment. People who have severe pain or limitations in daily life due to another bone, joint or muscle disease should inform the doctor in charge. Pseudoarthrosis also occurs after bone fractures or complicated operations. The patients at risk should inform the doctor about pain, especially if it occurs in connection with an accident or a surgical procedure. The bone condition is treated by an orthopedic surgeon or a specialist in bone diseases. Other points of contact are the physiotherapist and a sports medicine specialist. In addition, the condition usually requires further surgical intervention. After treatment, further progress controls are necessary. In addition, the physician should be consulted if unusual complaints occur.
Treatment and therapy
The therapy of pseudarthrosis depends on its exact form and the severity of the disease. Vital pseudarthrosis, which has been found to have adequate blood supply and sufficient fiber formation and ossification for good healing, requires mild forms of therapy. The main focus is on improving the mechanical framework of the fracture. This is achieved by osteosynthetic measures, for example with a ring fixator. Avital pseudarthrosis requires more extensive and complex therapeutic measures. Since this form of the disease no longer has sufficient healing powers, it requires much stronger medical measures than vital pseudarthrosis. Osteosynthesis is not sufficient, but is used for further stabilization. In addition, infected bone areas must be surgically removed while bone reconstruction is initiated. Surgical insertion of bone tissue into the fracture gap can help. Some physicians additionally prescribe their patients to take bone morphogenetic proteins to stimulate regeneration. Medication with BMP2 and BMP7 in particular has been shown to have good results.
Prevention
However, the therapy of pseudarthrosis starts at the follow-up of bone fractures, because the healing process can be observed through them. Thus, at the first signs of pseudarthrosis, rapid intervention is possible, and dangerous complications can be prevented. Patients at risk in particular should maintain regular contact with their physician after a bone fracture. Furthermore, patients with a bone fracture should adhere to the measures prescribed to them and not move the fracture or remove the cast too soon.
Aftercare
Aftercare for pseudoarthrosis depends on the underlying conditions and the effects that promoted the pseudoarthrosis. It is important to avoid fractures, as complications in the form of recurrent pseudoarthrosis can always occur during healing. If there is a deficiency of vitamin D and/or calcium, it is necessary that this be permanently corrected. This may require continuous supplementation of calcium and vitamin D through dietary supplements. Calcium and vitamin D levels should be checked regularly in the blood when such a therapy with dietary supplements is carried out. This can be done at the family doctor. If reduced blood circulation was the cause of pseudoarthrosis, permanent treatment with bone morphogenetic proteins, but also with blood thinning drugs (Macumar) may be necessary. If infectious diseases, arterial occlusive diseases or diabetes have been causally involved in the development of pseudoarthrosis, it is important to treat these permanently even after they have healed in order to prevent the recurrence of pseudoarthrosis. In the case of hypertrophic pseudoarthrosis without further causes, no special aftercare is possible after healing. Furthermore, the tendency for fractures not to heal properly persists in all types of pseudoarthrosis despite proper follow-up care.
Here’s what you can do yourself
Pseudoarthrosis must be diagnosed and treated by a doctor. Depending on the severity of the condition, patients can take some steps themselves to promote recovery and avoid complications. In principle, the physician’s recommendations regarding physical exercise and rest should be followed. Especially in the case of bone fractures, sufficient rest is important to prevent the development of pseudoarthrosis or to support its healing process. In everyday life, aids such as crutches or a wheelchair can make it easier to get around. Those affected can also help themselves by making various changes in the home, such as installing stairs suitable for the disabled. Contact with other affected persons is also recommended. Since people with pseudoarthrosis have limited mobility, physiotherapy or special yoga and aerobics programs are a good option. In addition, attention should always be paid to a healthy diet. The doctor will recommend a diet low in fat and salt and rich in vitamins and minerals. If, despite these measures, there is an increase in symptoms or other problems, the doctor must be informed so that treatment can be adjusted.