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 contributes to the restoration of its integrity. But fusion does not always go well. It happens that the fragments do not heal in any way, the edges of the bones, touching, eventually begin to grind, grind and smooth out, 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 appear. In medical practice, the most common false joint of the thigh and lower leg.
Features of pathology
Pseudarthrosis 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 leg, and this pathology is detected at the time when the child begins to take his first steps. There is also a congenital false joint of the clavicle. This malformation is very rare. However, he may also beacquired, which is very difficult to treat.
There is an acquired false joint after a fracture, when the bones do not grow together correctly. Quite often this happens after gunshot or open injuries. Sometimes its appearance is associated with some surgical interventions on the bones.
Reasons for the formation of pseudarthrosis
The development of pathology is associated with a violation of the normal process of bone tissue healing after a fracture. The common causes of the disease are 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 heal as a result of local causes:
- impaired blood supply to fragments;
- damage to the periosteum during surgery;
- reaction of the organism to metal osteosynthesis, rejection of nails and plates;
- bone fracture with numerous fragments;
- taking steroid hormones, anticoagulants;
- after the operation, the fragments were poorly compared relative to each other;
- the occurrence of a large distance between parts of the bones as a result of strong traction;
- infectious lesion, which led to the formation of suppuration in the area of the fracture;
- osteoporosis;
- immobility of the limb did not last long;
- damage to the skin,concomitant fracture - radiation, burns.
Changes that occur in the limb due to the formation of such a pathology as a false joint, in half of all cases contribute to persistent and severe disability of a person.
Formation of pseudoarthrosis
When a false joint begins to form, the gap formed by bone fragments is filled with connective tissue, and the bone plate closes the canal. This is the main difference between a false joint and a slow fusion of the bone.
As the disease begins to progress, mobility in such a “joint” increases. Typical articular surfaces are formed at the ends of bone fragments that articulate with each other. They also form articular cartilage. The altered fibrous tissues surrounding the "joint" form a "capsule" in which the synovial fluid occurs.
Symptoms of pathology
The symptoms of a false joint are quite specific, and the doctor is able to make a preliminary diagnosis only on the basis of them, after which it is confirmed by an x-ray.
- Pathological mobility in a place in the bone where it should not normally occur. In addition, the amplitude and direction of movements in the true joint may increase, which is impossible in a he althy person. This condition provokes a false joint of the femoral neck.
- Mobility in the pathological area may be barely noticeable, but sometimes occurs in all planes. In medical practice, there have been caseswhen the limb at the site of the false joint turned 360 degrees.
- Shortening the limb. It can reach ten centimeters or more.
- Atrophy of leg muscles.
- Severe limb dysfunction. To move, the patient uses crutches and other orthopedic devices.
- When leaning on the leg, pain appears in the area of pseudarthrosis.
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 two-bone segment. This happens if one of the two bones that make up the lower leg or forearm is affected.
Fracture of the neck of the femur is a very dangerous injury, especially if it occurs in the elderly. Women are more likely to undergo such a fracture, which is associated with the occurrence of osteoporosis during menopause. Osteoporosis contributes to a decrease in bone density, and it develops due to hormonal changes during menopause.
Diagnosis
To confirm the diagnosis, an X-ray method is used. A false joint on radiographs appears in two variants:
- Hypertrophic pseudarthrosis is a very rapid and excessive growth of bone tissue in the fracture area with normal blood supply. On x-ray, 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 orhis 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 site of the pathological formation.
Treatment
If a false joint has formed, its treatment is carried out only with the help of surgical intervention. In hypertrophic pseudoarthrosis, fragments are immobilized using metal osteosynthesis in combination with bone grafting. After that, within a few weeks, complete mineralization of the cartilage layer occurs and the bone begins to grow together. With atrophic pseudoarthrosis, areas of bone fragments are removed, in which the blood supply is impaired. Then parts of the bones are connected to each other, completely eliminating their mobility.
After the operation, massage, exercise therapy, physiotherapy are prescribed to restore muscle tone, mobility of nearby joints and improve blood supply.
Conclusion
Thus, we examined what a false joint is, the symptoms of this disease and its treatment were also considered. If a fracture occurs, it is necessary to follow all the recommendations of the doctor and not move the injured limb for as long as possible so that the bones grow together correctly. Otherwise, pseudoarthrosis can cause severe complications.
