False joint: causes, symptoms, diagnosis, treatment

A pseudoarthrosis is a diagnosis that excludes hopes for a cure using conservative methods. Their use in pseudoarthrosis is not justified and only prolongs the already protracted treatment period. In this case, surgery is indicated. The main goal of surgical treatment of a pseudoarthrosis is to remove scar tissue between the fragments, destroy the sclerotic bone in the area of the endplates and the contacting parts of the fragments, i.e. transform pseudoarthrosis into a normal fracture. The bone defects that arise as a result of the intervention are compensated for by plastic methods that also pursue a second goal - stimulation of osteogenesis. There are quite a lot of different surgical interventions. Some of them have only historical significance, others are used as an independent method of surgical treatment or as a stage in combination with others.

V. M. Arshin proposed a method of elastic automyocompression to eliminate pseudoarthrosis of long tubular bones. Distraction of fragments is performed on a pin. An autograft is taken near the fracture site, sawn into two equal parts and inserted between the bone fragments, eliminating distraction. Due to the elasticity of the tissues, autografts are pinched by the fragments. After the intervention, the limb is fixed with a plaster cast.

Currently, a method of closed treatment of pseudoarthrosis using the compression-distraction method has been developed and is widely used. The Ilizarov apparatus is applied as in the case of a bone fracture. Then compression is performed, as a result of which, due to excessive compression, destruction and resorption of bone and scar tissue occurs. After the disappearance of sclerotic areas and endplates, distraction of fragments begins, achieving consolidation and alignment of the length of the damaged segment in accordance with that of the healthy limb.

In case of loose pseudoarthroses with a bone defect, bilocal compression-distraction osteosynthesis according to G.A. Ilizarov is used. An external fixation device of 4 rings is mounted, 2 rings above and below the bone defect. An osteotomy is performed between the rings and gradual distraction of the fragments. In this way, a regenerate is grown in the osteotomy sites, restoring the original bone length, and the compressed ends of the fragments grow together.

Small bone defects can be corrected with bone grafting using autogenous bone, demineralized osteomatrix, or homobone.

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