The false joint

The false joint (pseudoarthrosis) - persistent bone defect that causes abnormal mobility for diaphysis. There are congenital and acquired false joints. The first are rare and are located primarily on the lower leg. Purchased are a complication of bone fracture. More often they are formed after open and gunshot fractures (see).

false joint of the shoulder
False joint of the shoulder

In the basis of false joint is the defect of the healing of fractures in force General and local reasons. To the common reasons include exhaustion, dysfunction of endocrine glands, lack of vitamins, neurotrophic disorders and other, local infection, a significant defects of soft tissues and bones, disruption of the blood supply and innervation, the interposition (hit) soft tissues between the fragments, the wrong method of treatment with unsatisfactory by reposition and fixation of fragments.
Clinically false joint is manifested painless mobility in the former site of the fracture, lack of fusion of fragments after a considerable time after the injury, impaired function of the leg (Fig.). Radiographically visible gap between the fragments and closure of bone marrow channels bone substance - the reflex album. In the false joint of the big old are formed typical articulate surfaces covered with cartilage; surrounding modified fibrous tissue are like the joint capsule.
Treatment of false joints only online. The technique of the surgery depends on the location, type and term of existence of false joint. Deletes modified fibrous soft tissues between fragments, economical resection ends of fragments, opening of bone marrow channel and solid fixation of fragments by means of osteosynthesis. For stimulating osteogenesis additionally use autologous bone - or gomotransplantation (see Bone grafting). Good results in the treatment of false joints observed in the application of apparatus of compression osteosynthesis (see).

False joint of [a synonym pseudoarthrosis (pseudoarthrosis)] - persistent abnormal mobility bones for diaphysis due to violation of continuity.
The false joint, with significant bone defect is called "dangling by pseudoarthrosis". HP may form and on short bones (patella, navicular bone, and others). HP are congenital and acquired.
Congenital false joints rare, mainly localized on the border of the middle and distal third of the leg, the result of intrauterine pathology. Purchased HP can be formed due to the lack of consolidation after a closed, open or gunshot fractures or after operations osteotomy, osteosynthesis, bloody reposition of fragments resulting from the weakness of reparative processes or significant loss of bone substance. Pathological fractures that occur when a minor injury can also lead to the formation of HP because of the reduced ability of the bone tissue regeneration (in rickets, osteomalacia, scurvy and other).
The basis of the pathogenesis of false joint - society and local reasons hindering the consolidation, the latter are much more prominent. To the common reasons include the violation of the functions of the endocrine glands, pregnancy, vitamin deficiency, chronic infectious diseases, wound depletion. Local reasons may be due to improper treatment (the excessive weight at traction, imperfect reposition bone fragments with the lack of contact, extensive resection of diaphysis or destruction of large bone fragment open fragmented fractures, the early application of active and passive gymnastics); anatomical and physiological features of the area of the fracture is a lack of blood flow to damaged bones (scaphoid, the neck of the femur, patella); feature of injury (multiple fractures, the interposition of soft tissue, loss of bone substance, crush of the soft tissues surrounding the fragments severe bone infection of a wound with the development of osteomyelitis).
Pathological anatomy. When the false joint, with close contact bone fragments their ends are connected by fibrous tissue. With long-term existence HP, one of the fragments takes the form of the joint socket, the other heads, both covered hyaline or fibrous cartilage, and the surrounding their fibrous tissue forms like joint bag with a cavity and likeness of synovial fluid. When the bone defect the ends of fragments sharpened, bone marrow channels sarasini, and the gap between the fragments made with scar tissue.
The clinical picture. In case of false joint, there is a more or less pronounced limb deformities, painless mobility of fragments, atrophy of the surrounding muscles and dysfunction of the limbs (Fig. 1, 2 and 2). The false joint, bone defect (dangling pseudoarthrosis) is characterized by the absence limb function and looseness for diaphysis bones.

Fig. 1. False joint of: 1 - left shoulder; 2 - right Shin.
Fig. 2. False joints: 1 - tibial bone defect fibula; 2 - the left femur with bone defect, visible reflex plate; 3 - the tibia (bone defect), the ends of fragments is pointed, with significant sclerotic changes in the soft tissues of the metal fragments.

Picture of a delayed consolidation slight swing of fragments, which usually causes pain. Radiographically seen a small gap between the fragments and cleft bone marrow channels. If the patient fails to operate, delayed Union is developing in the wrong joint.
Treatment HP aims to restore lasting contact between fragments for the normal function of the leg. As a rule, it is operational (see Osteosynthesis, Bone grafting). Method vneochagovogo compressive osteosynthesis by means of apparatus O. N. The Gudushauri provides full contact of fragments. It is applicable in cases of delayed consolidation and HP, acute osteomyelitis.
X-ray analysis (Fig. 2). Research methods: conventional radiography in two mutually perpendicular planes, tomography and functional x-ray examination.
For false joint is characterized by the following radiological symptoms. 1. Resistance bands enlightenment, sharing as related to the ends of fragments and periosteal osteophytes; anatomical substrate of this band enlightenment is radiolucent collagen tissue or fibrous cartilage (Century A. Rusakov). The form of a strip, and the angle between fragments vary in the functional study.
2. The appearance of a clear, gradually compactible and thicken at the cortical layer on the adjacent surfaces of all fragments (it occurs cellular-fibrous tissue produced by endosteum). Increasing smoothness, and sharpness before the uneven shape of the ends of fragments and closure of bone marrow channels (at the turn of divisov) - a sign that evolves false joint. In the bones of the limbs, especially periferica HP, noted progressive porous.
With long-term existence of HP and especially in bad immobilization touching the ends of fragments are shortened, smoothed and modeled like articular ends: one head, another depression. Further articulating such false joint may be complicated typical deformative-arthritiscom modifications until sclerosis and expansion edges articulated surfaces. HP should be differentiated from long flowing osteodes phase of consolidation (especially in flat and cancellous bone), delayed Union and especially with the area of perestroika bones and idiopathic posttraumatic osteolysis.