False joint (pseudo-arthrosis). Causes, Symptoms, Treatment

Traumatologists insist that the treatment of fractures and injuries should be carried out gradually. If the cast is removed too early, the loose ends of the bone can form a nonunion. It causes a lot of trouble, pain, becomes the reason of improper load distribution on the musculoskeletal system and spoils aesthetics.

Can a nonunion knit by itself? Usually patients who have faced such a problem come to Ladisten with this question. Experts working at the clinic are able to them using modern minimally invasive techniques.

What is false joint?

A nonunion or pseudoarthrosis is a pathology of a congenital and acquired nature, in case of which the continuity of the tubular bone is disrupted and mobility occurs in parts which are not typical to have it.

The pathology can be localized in different places. The nonunion in case of the ankle fracture usually has congenital nature. The rest of the “false joints” are formed after injury.

According to ICD-10, the nonunion is denoted by such codes:

• М84.0 (Malunion of fracture);
• М84.1 (Pseudoarthrosis);
• М84.2 (Delayed union of fracture).

The pathology does not form immediately. In order to confirm that the bones are not knitted properly, a certain period must pass. The Food and Drug Administration (FDA) describes the diagnosis of non-union if at least 9 months have passed since the fracture and no dynamics of callus formation are visible on X-rays over the past 3 months.

Causes

A congenital nonunion is formed because of the following reasons:

• intoxication;
• rickets;
•  tumors;
•  endocrine disorders.

Among all cases of pseudoarthrosis, the share of congenital pathologies reaches up to 4%. The remaining 96% are acquired. Their main causes are:

•         error during bone surgery – incorrect fixation, resection of fragments;
•         improper short-term rehabilitation – early removal of the fixation device, excessive load during the recovery period;
•         suppuration and infection.

At Ladisten, thorough diagnostics are carried out and the consequences of surgical errors are corrected.

Symptoms of pseudo-arthrosis, false joints

Does the nonunion hurt? Patients who have undergone surgery after a fracture and do not feel relief often ask about it. The answer is obvious: it hurts. But besides the pain, other symptoms are added. The main signs of improper knitting of tubular bones are as follows:

• the limb is deformed, the false formation bulges outward. It looks like a bump at the place of fracture;
• movements occur in the deformed area and the bone seems to be bent in half;
• as a result of pseudarthrosis of the legs, the supporting ability is affected. It is difficult for a person to stay on his or her feet and to walk;
• muscle strength decreases. Muscles gradually atrophy and movement in normal joints is limited;
• blood circulation in the limb is poor so it may grow numb.

If you suspect something is wrong after treating an injury or fracture, you should consult a doctor to perform timely diagnostics. If the process of formation of a nonunion is detected early, the prognosis is favorable.

Diagnostics of pseudo-arthrosis, false joints

In terms of clinical recommendations, X-ray is considered the main method used in order to confirm the diagnosis of nonunion. The images must be taken in frontal and lateral projections.

The main symptom of a nonunion is that there is no callus on the X-ray. The ends of the bone fragments are smoothed and rounded, the cavity at the level of the medullary canal is closed.

During diagnostics, the 1976 Weber-Cech classification is used. A nonunion can be:

• hypertrophic. The ends of bone fragments are thickened;
• atrophic. The ends of the fragments are conical;
• true. The ends of bone fragments are of different shapes. One is convex while the other is concave.

Treatment

If a nonunion is present, treatment is impossible without surgery. The damaged area is fixed again surgically for the formation of callus and ossification.

In order to achieve this, osteosynthesis according to Ilizarov is performed. For the operation, an external fixation device which the patient wears for about 6 months is used.

At Ladisten, surgical manipulations are carried out in a minimally invasive way. The method has proven its effectiveness over 30 years of practice. Veklich’s device, which is the new design being used, has a patent. Dr. Veklich’s device is a reliable unit for bone knitting with low weight and improved ergonomics. It doesn’t include traumatic needles, thereby reducing the risk of infection and the duration of rehabilitation.

Preventive measures: how to prevent the formation of a nonunion

Early diagnostics and treatment of fractures is the first step in prevention. The main measures include:

• performing operations on injured limbs instead of putting on a cast if the patient has low resistance;
• increasing the operation time in order to ensure normal fixation of fragments;
• avoidance of early removal of the fixation device, cast or spokes;
• avoidance of overloading the injured limb for six months after the operation.

If the doctor’s recommendations are followed, the risk of pathology development is reduced.