False joint is a kind of discontinuity of the bone, which is characterized by pathological mobility, unusual for this department. In medical practice, a special term is used for this condition - "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 analyze in detail the causes of the formation of a false joint. We will also pay attention to diagnostics 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, the code that has a false joint is ICD 10. It includes: nonunion of a fracture, that is, pseudoarthrosis, and a false joint against the background of fusion or arthrodesis.
From the sidepathomorphological picture and method of treatment false joints are divided into fibrous and true. The former are an intermediate stage between slow consolidation and true pseudarthrosis. Their clinical picture is an insignificant gap between the fragments, filled with fibrous tissue, the ends have bone plates that close 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. Synovial fluid accumulates between them, sclerosis of the ends of the fragments is possible.
Classification of false joints
False joint can be congenital or acquired. The congenital false joint is extremely rare and accounts for no more than 0.5% of the pathology. Its formation is based on an 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 broken. As a rule, a 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 there is an incorrect and incomplete union of fragments. Acquired pseudoarthrosis is divided into atrophic, normotrophic and hypertrophic.
Local causes of disease
Local causes of educationfalse joint, in turn, are divided into three groups. The first group - the reasons that are associated with errors and shortcomings in the treatment: incomplete comparison of bone fragments, failure to eliminate soft tissue interposition, incorrect immobilization, due to which the mobility of fragments remains, frequent or early change of plaster casts, the use of an incorrect fixator, 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, crushing of the muscle over a considerable extent, bone exposure, suppuration of tissues, osteomyelitis, damage to nerves and blood vessels, as well as violation food in them.
And, finally, the third group of causes affecting the formation of a false joint is associated with the anatomical and physiological characteristics of the blood supply to 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 especially calcium-phosphorus metabolism in tissues; diabetes; avitaminosis; vascular insufficiency after damage to the innervation of blood vessels; significant X-ray exposure, 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 site of the fracturethere is mobility, atrophy of muscle tissue, swelling, proliferation of connective tissue, scar formation. An x-ray can detect a significant gap between the fragments, sclerosis at the ends of the bones, fusion of the medullary canal.
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 union of this fracture. When this period expires, the status of the fracture is determined as slowly healed or not healed, and after a period of twice the normal period, 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 in oblique projections. Signs of the presence of a false joint are the following x-ray picture: the absence of a callus, which is the connecting part of bone fragments; the ends of the fragments have a smoothed rounded or conical shape; the cavity at the ends of the fragments overgrows and the closing plate is formed. With a false joint in one or both bone fragments, the end has a hemispherical shape, and in appearance resembles an articular head. Another fragment may have an articular cavity. In this case, the joint space is clearly visible.
To determine the degree of intensity of the process, a radionuclide study is prescribed.
Principles of surgical treatment
Despite the whole arsenal of conservative methods of treatment (injection of drugs, electrical stimulation, magnetic therapy, etc.), the mainthe method of treatment of pseudarthrosis is operational. The leading place is occupied by compression osteosynthesis. How to properly treat a false joint? The operation should be carried out 8-12 months after the complete healing of the wound in complex fractures. If there are scars soldered 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 pvseudarthrosis using the Ilizarov apparatus
This method allows you to bring the fragments together and contributes to their rapid fusion without direct surgical intervention. That is why this method is called extrafocal osteosynthesis.
To begin with, the patient is placed on the spokes of the orthopedic apparatus, with the help of which bone fragments are fixed. Then, about a week, the recovery process after the application of the apparatus lasts, during which the places where the spokes pass heal and the process of bone fusion itself begins. Gradually, bone fragments move closer to each other, destroying unnecessary connections and squeezing the false joint.
Further, fixation occurs, that is, the formation of a callus and the process of its ossification. This period is long, but at the same time safe and does not require special measures. The patient should take vitamins, eat right and give up bad habits.
And finally,the last is the rehabilitation period, during which it is necessary to follow all the instructions of the doctor and do a set of special exercises. Walking and swimming are considered ideal at this time.
Intra- and extramedullary osteosynthesis
An effective method of surgical treatment is intramedullary synthesis. Before it is carried out, the doctor removes damaged soft tissues in which there is no periosteum and blood clots. After that, the 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 fixator. It is pressed against the damaged bone, and after the fragments have fused, the plate is removed using an incision.
So, in the article pseudarthrosis was discussed in detail. In conclusion, it should be noted that risk factors for the formation of a false joint are various endocrine diseases, bad habits (smoking, alcohol abuse), obesity, malnutrition and lack of physical activity. Therefore, maintaining a he althy lifestyle will reduce the risk of this disease.
