False joint is a kind of violation of bone continuity, which is characterized by pathological mobility, which is uncommon for this department. In medical practice for such a state use a special term - "pseudoarthrosis".Currently, such a disease is quite successfully treated, and the methods of treatment can be both operational 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 discuss in detail the causes of the formation of a false joint. And also we will pay attention to diagnostics and methods of treatment.
ICD: false joint, varieties
False joint - a violation of the integrity of the tubular bone, accompanied by pathological mobility. According to the international classification of diseases, the code that has a false joint is ICD 10. It includes: non-growth of the fracture, i.e. pseudoarthrosis, and a false joint on the background of fusion or arthrodesis.
On the part of the pathomorphological picture and method of treatment, false joints are divided into fibrous and true joints. The first 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 the bone fragments are encapsulated in a peculiar connective tissue capsule. Between them the synovial fluid accumulates, the sclerosis of the ends of the fragments is possible.
Classification of false joints
False joint may be congenital or acquired. The fake congenital joint is extremely rare and is no more than 0.5% of the pathology. At the heart of its formation is the intrauterine disruption of the formation of bone tissue, resulting in an inadequate bone structure in a certain area. And after birth, by 2-3 years, the integrity of the bone is broken. As a rule, the false joint of the lower leg is congenital, more rarely - the clavicle, the ulnar and the femur.
Acquired false joint is about 3% of diseases of an orthopedic nature. In most cases, it is a consequence of a fracture, when there is an incorrect and incomplete fusion of fragments. Acquired pseudarthrosis is divided into atrophic, normotrophic and hypertrophic.
Local causes of the disease
Local causes of the formation of the false joint, in turn, are divided into three groups. The first group - the reasons that are associated with errors and deficiencies in the treatment: incomplete comparison of bone fragments, non-elimination of the interposition of soft tissues, improper immobilization, due to which fragility mobility persists, frequent or early change of casts, use of an incorrect fixative, too active movements and physical load, extensive sclerotization.
The second group includes the reasons related to the severity of the injury and post-traumatic complications: fractures, loss of a large part of the bone, crushing of the muscle over a considerable extent, bone exposure, tissue suppuration, osteomyelitis, nerve and vessel damage, and malnutrition.
And, at last, the third group of the reasons influencing formation of a false joint, is connected with anatomic and physiological features of blood supply in a bone and a place of localization of a fracture.
From 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 innervation of blood vessels;significant x-ray irradiation, which is able to inhibit the process of osteogenesis;trophic disorders in the fracture site.
The clinical picture at formation of a false joint has the characteristic features. In the place of fracture there is mobility, atrophy of muscle tissue, swelling, proliferation of connective tissue, scar formation. On the X-ray, you can find a significant gap between the fragments, sclerosis at the ends of bones, fusion of the medullary canal.
Diagnosis of pseudarthritis
In the diagnosis, in addition to clinical data, attention is paid to the time required for the complete fusion of this fracture. When this period expires, the fracture status is defined as slowly fused or not merged, and after the expiration of a period twice exceeding the norm, the formation of a false joint is suspected.
To confirm the hypothesis, the x-ray is made in two mutually perpendicular projections, and in some cases - in oblique projections. The following picture on the x-ray is the signs of the presence of a false joint: the absence of bone callus, which is the connecting part of bone fragments;the ends of the fragments have a rounded or conical shape that is flattened;The cavity at the ends of the fragments grows and a closing plate is formed. With a false joint in one or both bone fragments, the end has a hemispherical shape, and looks like an articular head. Another fragment may have an articular cavity. In this case, the joint gap is clearly visible.
To determine the degree of intensity of the process, a radionuclide study is prescribed.
Principles of surgical treatment of
Despite the whole arsenal of conservative methods of treatment( drug administration, electrostimulation, magnetotherapy, etc.), the main method of treating pseudoarthrosis is operative. The leading place is occupied by compression osteosynthesis. How correctly to treat a false joint? The operation should be performed 8-12 months after the wound is fully healed with complex fractures. If there are scars welded to the bone, they must be excised and plastic surgery should be performed to remove the defect.
An important point in the operation is an accurate comparison of bone fragments, as well as refreshment of their ends, excision of scar tissue and restoration of patency of bone marrow canals.
Treatment of pseudoarthrosis on the Ilizarov device
This method allows to bring the fragments together and facilitate their fast fusion without direct operative intervention. That is why this method was called extra-osteosynthesis.
For the beginning the patient is put on the spokes of the orthopedic device, by means of which bone fragments are fixed. Then about a week, the process of recovery after the application of the device lasts, during which the places where the spokes pass, heal and the process of bone adhesion begins. Gradually, bone fragments are brought together, destroying unnecessary connections and squeezing a false joint.
Then there is fixation, that is, the formation of corn and the process of its ossification. This period is long, but at the same time it is safe and does not require special measures. The patient should take vitamins, eat right and give up bad habits.
Finally, the last is the rehabilitation period, during which it is necessary to follow all the doctor's instructions 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 is carried out, the doctor removes damaged soft tissue, in which there is no periosteum and blood clots. After this, the bone fragments are fixed by means of a special pin. The wound after the operation is sewn on the layers, in its place may remain a small scar.
During extramedullary osteosynthesis, bone fragments are fastened with a periosteal fixator. It is pressed against the damaged bone, and after the fracture is broken, the plate is removed by means of a cut.
So, in the article pseudoarthrosis was considered in detail. In conclusion, it should be noted that various endocrine diseases, bad habits( smoking, alcohol abuse), obesity, malnutrition and lack of physical activity are risk factors for the formation of a false joint. Therefore, maintaining a healthy lifestyle will reduce the risk of this disease.