Bone healing after a fracture occurs due to the formation of "bone callus" - a loose shapeless tissue that connects parts of a broken bone and helps to restore its integrity. But intergrowth does not always proceed safely. It happens that the fragments do not heal in any way, the edges of the bones, in contact, begin to grind, grind and smooth over time, leading to the formation of a false joint (pseudoarthrosis). In some cases, a layer of cartilage may appear on the surface of the fragments and a small amount of joint fluid may occur. In medical practice, the most common false joint of the thigh and lower leg.
Pathology Features
Pseudoarthrosis is usually acquired or, in rare cases, congenital. It is assumed that such a congenital ailment is formed as a result of a violation of bone formation in the prenatal period. Usually pseudoarthrosis is localized in the lower part of the lower leg, and this pathology is revealed at the time when the child begins to take his first steps. There is also a congenital false joint of the clavicle. Such a malformation is very rare. However, it can also be acquired, which is very difficult to treat.
An acquired pseudoarthrosis occurs after a fracture, when the bones are not properly fused. Quite often this happens after gunshot or open injuries. Sometimes its appearance is associated with some surgical interventions on the bones.
Causes of the formation of pseudoarthrosis
The development of pathology is associated with a violation of the normal healing process of bone tissue after a fracture. The general causes of the disease are caused by diseases in which there is a violation of the reparative regeneration of bones and metabolism:
- rickets;
- multiple injuries;
- pregnancy;
- endocrinopathy;
- intoxication;
- tumor cachexia.
Bone fragments usually do not fuse as a result of local causes:
- violation of the supply of blood fragments;
- damage to the periosteum during the operation;
- body reaction to metal osteosynthesis, rejection of nails and plates;
- bone fracture with numerous fragments;
- taking steroid hormones, anticoagulants;
- after the operation, fragments are poorly compared relative to each other;
- the appearance of a large distance between the parts of the bones as a result of strong traction;
- infectious lesion, which led to the formation of suppuration in the fracture area;
- osteoporosis;
- limb immobility did not last long;
- damage to the skin accompanying a fracture - radiation, burns.
Changes that occur in a limb due to the formation of a pathology such as a false joint, in half of all cases contribute to persistent and severe disability of a person.
The formation of pseudoarthrosis
When the pseudoarthrosis begins to form, the gap formed by bone fragments can be filled with connective tissue, and the bone plate closes the canal. This is the main difference between a false joint and a slow bone fusion.
As the disease begins to progress, mobility in such a “joint” increases. The formation of typical articular surfaces at the ends of bone fragments articulating with each other. Articular cartilage is also formed on them. Altered fibrous tissues surrounding the “joint” form a “capsule” in which synovial fluid occurs.
Symptoms of pathology
Symptoms of the false joint are quite specific, and the doctor is able to make a preliminary diagnosis only on their basis, after which it is confirmed by an x-ray.
- Pathological mobility in a place in the bone where it usually should not occur. In addition, the amplitude and direction of movements in the true joint may increase, which is impossible in a healthy person. This condition provokes a false joint of the femoral neck.
- Mobility in the pathological area can be barely noticeable, but sometimes it is carried out in all planes. In medical practice, there have been cases when the limb at the site of the pseudoarthrosis was rotated 360 degrees.
- Limb shortening. It can reach ten centimeters and more.
- Atrophy of the leg muscles.
- Severely impaired limb function. To move, the patient uses crutches and other orthopedic appliances.
- When resting on the leg, pain appears in the area of pseudoarthrosis.
But there are cases when the symptoms of the pathology appear slightly or may even be absent during the formation of a false joint on one of the bones of the bony segment. This happens if one of the two bones that form the lower leg or forearm is affected.
A hip fracture is a very dangerous injury, especially if it occurs in older people. Women are more likely to undergo such a fracture, which is associated with the occurrence of osteoporosis during menopause. Osteoporosis helps to reduce bone density, and it develops due to hormonal changes during menopause.
Diagnostics
To confirm the diagnosis, use the x-ray method. The false joint on radiographs is manifested in two versions:
- Hypertrophic pseudoarthrosis is a very rapid and excessive overgrowth of bone tissue in the fracture area with normal blood supply. On x-rays, you can see a significant increase in the distance between the ends of the bone fragments.
- Atrophic - the occurrence of a false joint occurs with insufficient blood supply or its absence. On the radiograph, you can clearly see the clear boundaries of the edges of the fragments held by the connective tissue, but it is not too strong to immobilize the area of pathological formation.
Treatment
If a false joint has formed, its treatment is carried out only with the help of surgical intervention. With hypertrophic pseudoarthrosis, fragments are immobilized using metal osteosynthesis in combination with bone grafting. After that, within a few weeks, the cartilaginous layer is completely mineralized and the bone begins to grow together. With atrophic pseudoarthrosis, sections of bone fragments in which blood supply is disturbed are removed. Then the parts of the bones are connected to each other, completely excluding their mobility.
After the operation, to restore muscle tone, mobility of nearby joints and improve blood supply, massage, exercise therapy, and physiotherapy are prescribed.
Conclusion
Thus, we examined what a false joint is, the symptoms of this disease and its treatment were also considered. If a fracture occurs, you must follow all the doctor's recommendations and do not move the injured limb as long as possible so that the bones are properly healed. Otherwise, pseudoarthrosis can cause severe complications.