The false joint is a kind of violation of the continuity of the bone, which is characterized by pathological mobility, unusual for this department. In medical practice, a special term is used for such a condition - "pseudoarthrosis". Currently, such a disease is quite successfully treated, and treatment methods can be both surgical and conservative. In addition, treatment in most cases has a positive outcome and returns a person to a normal life. In this article, we will analyze in detail the causes of the formation of a false joint. And also pay attention to the diagnosis and treatment methods.
ICD: false joint, varieties
False joint - violation of the integrity of the tubular bone, accompanied by pathological mobility. According to the international classification of diseases, a code that has a pseudoarthrosis is ICD 10. It includes: non-healing of the fracture, that is, pseudo-arthrosis, and the pseudoarthrosis against the background of fusion or arthrodesis.
From the pathomorphological picture and the method of treatment, the false joints are divided into fibrous and true. The former are an intermediate stage between slow consolidation and true pseudoarthrosis. Their clinical picture is a small gap between the fragments, filled with fibrous tissue, the ends have bone plates covering the medullary canal.
In rare cases, fibro-synovial pseudoarthrosis is formed, in which the ends of the bones are covered with cartilaginous tissue, and bone fragments are enclosed in a kind of connective tissue capsule. Between them, synovial fluid accumulates , sclerosis of the ends of the fragments is possible.
Classification of false joints
The false joint may be congenital or acquired. Congenital pseudarthrosis is extremely rare and makes up no more than 0.5% of the pathology. The basis of its formation is intrauterine violation of the formation of bone tissue, resulting in an inferior bone structure in a certain area. And after birth, by 2-3 years, the integrity of the bone is violated. As a rule, the false joint of the lower leg is congenital, less often - the clavicle, ulna and femur.
Acquired false joint accounts for about 3% of orthopedic diseases. In most cases, it is the result of a fracture, when abnormal and incomplete fusion of fragments occurs. Acquired pseudoarthrosis is divided into atrophic, normotrophic and hypertrophic.
Local causes of the disease
Local causes of the formation of a false joint, in turn, are divided into three groups. The first group - the reasons that are associated with errors and shortcomings in treatment: incomplete comparison of bone fragments, failure to remove soft tissue interposition, improper immobilization, due to which fragments remain mobile, frequent or early change of gypsum dressings, use of the wrong fixative, too active movements and physical activity extensive sclerotation.
The second group includes causes related to the severity of the injury and post-traumatic complications: fractures, loss of a large part of the bone, muscle crushing over a considerable length, bone exposure, suppuration of tissues, osteomyelitis, damage to nerves and blood vessels, as well as disturbance in their nutrition.
And, finally, the third group of causes affecting the formation of the pseudoarthrosis is associated with the anatomical and physiological features of blood supply in the bone and the location of the fracture.
Trophic causes
Of the mass of trophic causes, the main ones in the formation of a false joint are: infections, for example, syphilis, malaria, acute infections; metabolic disorders, and in particular calcium-phosphorus metabolism in tissues; diabetes; avitaminosis; vascular insufficiency after damage to the innervation of blood vessels; significant x-ray irradiation, which can inhibit the process of osteogenesis; trophic disorders at the fracture site.
Clinical picture
The clinical picture in the formation of a false joint has its own characteristics. At the fracture site, mobility, atrophy of muscle tissue, swelling, proliferation of connective tissue, and scar formation are observed. On the X-ray, a significant gap between the fragments, sclerosis at the ends of the bones, and fusion of the bone marrow canal can be found.
Diagnosis of pseudoarthrosis
When making a diagnosis, in addition to clinical data, attention is also paid to the period that is necessary for the complete fusion of this fracture. When this period expires, the status of the fracture is defined as slowly fused or not fused, and after the expiration of a period twice exceeding the norm, the formation of a false joint is suspected.
To confirm the hypothesis, an x-ray is taken in two mutually perpendicular projections, and in some cases also in oblique projections. Signs of the presence of a false joint are considered the following picture on an x-ray: lack of bone callus, which is a connecting part of bone fragments; the ends of the fragments have a smooth rounded or conical shape; a cavity at the ends of the fragments overgrows and a trailing plate forms. With a false joint in one or both bone fragments, the end has a hemispherical shape, and in appearance resembles a joint head. Another fragment may have an articular cavity. In this case, the articular gap is clearly visible.
To determine the degree of intensity of the process, a radionuclide study is prescribed.
Principles of surgical treatment
Despite a whole arsenal of conservative methods of treatment (drug administration, electrical stimulation, magnetotherapy, etc.), the main way to treat pseudarthrosis is surgical. The leading place is compression osteosynthesis. How to treat a false joint? The operation should be carried out 8-12 months after the complete healing of the wound with complex fractures. If there are scars welded to the bone, they must be excised and plastic surgery performed to eliminate the defect.
An important point in the operation is the exact comparison of bone fragments, as well as the refreshment of their ends, excision of scar tissue and restoration of patency of the bone marrow canals.
Treatment of pseudoarthrosis with Ilizarov apparatus
This method allows you to bring fragments closer together and contributes to their rapid fusion without direct surgical intervention. That is why this method is called extra-focal osteosynthesis.
To begin with, the patient is placed with spokes of the orthopedic apparatus, with which bone fragments are fixed. Then, the recovery process after applying the apparatus lasts about a week, during which the places where the spokes pass, heal and the process of bone fusion begins. Gradually, bone fragments bring them closer together, destroying unnecessary connections and squeezing the pseudoarthrosis.
Then fixation takes place, that is, the formation of corn and the process of its ossification. This period is long, but safe and does not require special events. The patient should take vitamins, eat right and give up bad habits.
And finally, the last is the period of rehabilitation, during which it is necessary to observe all the instructions of the doctor and do a set of special exercises. Ideal at this time are walking, swimming.
Intra- and extramedullary osteosynthesis
An effective method of surgical treatment is intramedullary synthesis. Before it, the doctor removes the damaged soft tissues, in which there is no periosteum and blood clots. After this, bone fragments are fastened with a special pin. The wound after the operation is sutured in layers, a small scar may remain in its place.
During extramedullary osteosynthesis, bone fragments are fastened with a periosteal fixative. It is pressed against the damaged bone, and after the fusion of the fragments, the plate is removed using an incision.
So, the article examined in detail pseudoarthrosis. In conclusion, it should be noted that various endocrine diseases, bad habits (smoking, alcohol abuse), obesity, malnutrition and lack of physical activity serve as risk factors for the formation of a pseudoarthrosis. Therefore, maintaining a healthy lifestyle will reduce the risk of this disease.