Bone healing is multifactorial and depends on:
- Intact blood supply
- Vital bone cells: bone formation
- Sufficient stability following fractures
Definition and example of pseudarthrosis
The x-rays show a break as the expression of an unhealed bone fracture = pseudarthrosis (formation of false joint) just above the upper ankle joint.
Case study
In general, there is an increased risk of developing pseudarthrosis following an open fracture.
The following injuries cause interruptions to the blood supply:
- Open fracture
- Severe soft tissue damage
Unstable osteosynthesis – a risk factor for the development of pseudarthrosis
Case studies
Plate broken and pulled away from the clavicle
X-ray diagnostics
Case study
Conventional x-rays do not always provide clear information facilitating the diagnosis of pseudarthrosis!
Additional diagnostic procedures with computed tomography images of the pseudarthrosis region show findings typical of pseudarthrosis
The CT images show a broken screw and a gap in the bone
The following therapeutic principles are applied when treating pseudarthrosis
- Increased stability:
- nail filling the medullary cavity
- fixed-angle bridge plate
- Correction of bone malpositioning
- Biological activation
Implants to stabilise the bone: modern fixed-angle bridge plate
Case studies of the surgical treatment of pseudarthrosis
- X-ray analysis of humeral shaft pseudarthrosis following plate osteosynthesis shows the following:
- The plate and screws have become loose
- The fracture has not healed
- The bone is unstable
Operation:
- Removal of the loose plate
- Resection of the scar tissue which is preventing the formation of new bone
- Substitution of long fixed-angle bridging plate
- Grafting of autologous bone and application of bone growth factor BMP-2
- X-ray analysis of tibial pseudarthrosis following insertion of intramedullary nail shows the following
- The fracture has not healed
- The intramedullary nail is unstable and the distal locking screw has been removed
The standard surgical treatment for pseudarthrosis of the lower leg entails replacing the intramedullary nail:
- Reaming and thus “refreshing” the bone marrow cavity
- Implantation of a stable intramedullary nail
- Compression of the pseudarthrosis zone
- Stability increased by inserting locking screws in distal region
- The image shows complete bone regeneration in the former pseudarthrosis zone after a period of 3 months
The image on the right shows the removal of the metal after approx. 1 year
The following procedures are used for the biological activation of the pseudarthrosis region
- Grafting of bone from the iliac crest
- Application of bone growth factors
- Blood collection from the iliac crest
The RIA system is another way of harvesting autologous bone
- Harvesting cancellous bone from the osseous canal, e.g. in the thigh