A bone fracture is painful and requires a lot of patience from the patient. Depending on which bone has been affected, healing can take several weeks or even months. However, if a bone has not healed properly even after more than six months and is still causing problems, pseudarthrosis may have developed .
Find out here what pseudoarthrosis is, what characteristics it has and which forms of therapy can be promising, as well as selected pseudoarthrosis specialists.
With this type of complaint, you should not necessarily be guided by the name alone. It has nothing to do with normal osteoarthritis, which is usually caused by joint wear and tear.
The term "pseudarthrosis" is made up of "pseud" and "arthros". "Pseud" stands for false, "arthros" for joint. Pseudoarthrosis is therefore a false joint that occurs when fracture sites have not healed sufficiently after a bone fracture.
Although the bone ends grow together and form a joint, this does not become firm and stable, as it should be. As a result, a joint is formed between the fracture ends in the area of the former fracture site, which did not exist before. This false joint can lead to considerable problems such as pain and restricted movement. Pseudo and false joint are other terms under which pseudoarthrosis is known.
Normal undisturbed fracture healing takes around 4 to 6 weeks, but can also take longer, up to 12 weeks, in the case of complex fractures.
If a fracture has not healed after 12 weeks, this is referred to as delayed fracture healing, and after 6 months it is a case of pseudoarthrosis.
Long bones, also known as shaft bones, are particularly susceptible to pseudoarthrosis. These include the femur, scaphoid, ulna with radius and the humerus.
Pseudarthrosis in the forearm
Pseudarthrosis can have various causes. A basic distinction is made between mechanical and morbid causes of pseudarthrosis. Mechanical means that movement and pressure have led to a disruption in bone fracture healing. Morbid causes are pathological conditions outside the bone, most frequently metabolic disorders or pathogens.
Mechanical causes basically include everything that has to do with movement, most frequently premature loading and therefore insufficient immobilization. This is particularly important in the case of conservatively treated fractures. Conservative means that the ends of the bones are not fixed together by surgery using metal (wires, screws, plates), but that the aim is to allow the fracture to heal naturally. Surgical treatment is also known as osteosynthesis, "osteo" stands for bone and "synthesis" for union.
A prerequisite for conservative fracture treatment is that the bone ends are close together and in the correct position. Immobilization is usually carried out using a plaster cast (e.g. on the wrist) or physical rest (e.g. for rib fractures).
A fracture normally heals within 6 weeks. If the bone tissue has not yet healed, premature movement and weight-bearing can ultimately do more harm than good and, in the worst case, lead to pseudoarthrosis.
Other mechanical causes can be
Morbid causes must also be taken into account, but are much rarer. This category includes
Morbid causes also include congenital metabolic disorders of the bone, although these are rarely the cause.
Pseudarthrosis can be divided into different categories based on the bone structure and the blood supply situation:
There is often a combination of hypertrophic & vital on the one hand and atrophic & avital on the other. Atrophic avital pseudarthrosis has the worst chances of healing, but hypertrophic vital pseudarthrosis also often has a protracted and complex healing process and often has to be surgically revised to ensure correct healing in the correct axial position (i.e. without skewing).
There are various signs that indicate pseudarthrosis. For example, a very slow-healing fracture can be the first sign. Persistent or even increasing pain - lasting longer than 4 to 6 months - is suspicious of pseudarthrosis. Typical symptoms can be
If you experience these symptoms, you should definitely have a medical check-up and have the symptoms investigated. Imaging procedures, primarily an X-ray examination, can make the pseudarthrosis visible and enable a more precise diagnosis. The X-ray image shows a permanent bone gap at the site of the previous fracture that has not healed properly. Pseudarthrosis can be assessed even more precisely using computer tomography or magnetic resonance imaging .
The treatment depends on the type of pseudarthrosis. The treatment methods must be adapted to the respective cause. In the case of the vital form, a somewhat milder therapy can be used and the chances of recovery are very good. A consistent continuation of immobilization is often sufficient.
The situation is different with avital pseudarthrosis, which usually requires surgical intervention. With the help of so-called osteosynthetic measures (bone connections using metal plates or screws), good treatment success can often be achieved.
In most cases, the bone ends have to be "refreshed". This means that dead avital and infected bone tissue is removed. In some cases, however, this results in a defect in the bone structure, making it necessary to fill it by means of a bone donation. This can be done using a cell culture of the patient created specifically for this purpose or bone tissue is removed from another site. The iliac crest is a suitable donor site.
A ring fixator is a variant that is used to stabilize the bone. A ring fixator is a type of external holding system that can be easily removed again.
Also important: there is currently a lot of discussion about a blood test to predict susceptibility to pseudoarthrosis. If this is successful, appropriate measures can be taken directly at the time of the initial fracture. In addition, tissue samples from the section of bone affected by pseudoarthrosis can also be examined in a laboratory. This provides a better overview of the risk of pseudarthrosis and the chances of healing a fracture.
In summary, the following treatment measures are available for pseudarthrosis:
Several specialists may be involved in the treatment of pseudoarthrosis. For example, physicians from the field of bone surgery and specialists from the field of orthopaedics may be involved. The attending physician will refer the patient to the right expert.
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