False joint after fracture: symptoms and treatment

False joint after fracture: causes, treatment

When the bones grow together after a fracture, a "bone callus" is formed, which is a formless and loose mass, due to which the restoration of bone tissue occurs between the fragments.

For a more precise fusion of bones, various techniques are used: the application of gypsum, the extension of the bones of the skeleton, the connection of fragments by metal plates, spokes,

However, under the influence of various factors, in a number of cases, the tubular bone does not coalesce. After a while its contiguous and rubbing edges smooth out and form a false joint (or pseudoarthrosis) - one of the complications in the treatment of fractures.

Sometimes a thin layer of cartilage and fluid forms on the edges of the bones of this formation, and a capsule similar to the articular bag appears around it.

The first attempts to treat such complications of fractures were undertaken by Hippocrates. They were not successful, because.

for these purposes only conservative methods were used - tapping a damaged area with a wooden hammer and injecting drugs to activate the growth of the bone callus.

According to some statistics, this complication in the treatment of closed fractures is observed in 5-11% of cases, and open - in 8-35%.

Pseudoarthritis often occurs after injuries of the radius and neck of the thigh, and with congenital pathology - on the shin (at the border of the lower and middle third of the tibia).

In this article we will acquaint you with the causes of the appearance, varieties, basic symptoms and methods of treatment of pseudoarthrosis.

Causes

The cause of the formation of a false joint may be incorrect immobilization of the limb after fracture and displacement of bone fragments.

The appearance of a congenital false joint is provoked by intrauterine pathologies. They are more often unilateral and appear on the tibia.

The frequency of their development is on average 1 case per 190 thousand children. The appearance may be caused by the following intrauterine pathologies:

The development of acquired false joints can be caused by such internal or external causes:

• improper treatment of fractures - displacement of bone fragments under gypsum, improper limb immobilization by gypsum dressing, frequent replacement of gypsum, overgrowth with skeletal traction, insufficient immobilization of the limb after osteosynthesis, early and excessive loads on the fractured limb, premature removal of the device for fixation fragments;
• consequences of surgical interventions - resection of fragments, fragile fixation;
• diseases that lead to disruption of normal regeneration of bones and metabolism (for example, rickets, endocrine pathologies, tumor cachexia, general intoxication);
• suppurative complications.

The appearance of acquired pseudoarthrosis can occur in such cases:

• the penetration of soft tissues or foreign bodies into the gap between the ends of the broken bone;
• excessive amount of fragments;
• improper comparison of the ends of a broken bone;
• osteoporosis;
• insufficient blood circulation in the area of ​​fragments;
• large distance between the ends of the broken bone;
• absence of a bruise between the ends of a broken bone;
• trauma of the periosteum during surgical manipulation;
• reaction at metalloesteosynthesis on devices from metal (plates, bolts, nails);
• clogging and closing of the bone marrow canal in fragments;
• additional tissue damage (burns, irradiation);
• reception of anticoagulants or steroids.

Types of false joints

Depending on the cause of pseudoarthrosis, there are:

• congenital;
• acquired: pathological and traumatic.

Depending on the nature of the damage, pseudoarthrosis can be:

• non-fire resistant;
• firearms.

Depending on the clinical manifestations revealed during an X-ray, false joints are of these types:

1. Forming. Appears during the completion of the period necessary for normal bone growth. On the x-ray, clear boundaries of the "gap" of the fracture and bone callus are determined. The patient feels pain in the damaged area and at attempts of its probing.
2. Fibrous. Between the ends of the bone, fibrous tissue is revealed and a narrow "slit" is visible in the picture. Mobility in the joint is severely restricted.
3. Necrotic. Appears after gunshot wounds or fractures that predispose to the development of necrosis of bones. Such pseudoarthrosis is more often observed with injuries of the neck of the talus and femoral or median part of the scaphoid bone.
4. Pseudoarthritis of bone regenerate. Appears with an incorrect osteotomy of the tibia with excessive stretching or insufficient fixation to the device for lengthening the segments.
5. True (or neoarthrosis). In most cases, it develops on single-bone segments with excessive mobility. With such pseudoarthrosis, a fibrous cartilaginous tissue with hyaline cartilage regions appears on the edges of the fragments. Around the wreckage there is an appearance similar to the periarticular bag containing the liquid.

Depending on the method of formation and intensity of bone formation, pseudoarthroses are:

• hypertrophic - on the ends of the broken bone appears proliferation of bone tissue;
• normotrophic - there are no bone growths on the fragments;
• Atrophic (or avascular) - in such joints blood circulation is disturbed, bone formation is poor or is often accompanied by osteoporosis of the broken bone.

In its current, pseudoarthrosis can be:

• uncomplicated - are not accompanied by infection and the appearance of pus;
• infected - the attachment of a purulent infection leads to the formation of bone localized fistula and sequestrants (cavities) from which pus is secreted, in such joints can be present fragments of shells or metal fixatives.

Symptoms

With the false joint, the following main symptoms are observed:

• atypical unobtrusive or extremely pronounced mobility of those parts of the body in which motion does not arise in the norm;
• uncharacteristic increase in the direction or amplitude of movements;
• reduction of arm or leg length up to 10 cm;
• edema below the fracture site;
• reduction of limb muscle strength with pseudoarthrosis;
• violation of the functions of the broken limb;
• changes in the functions of the nearest joints.

Diagnostics

In addition to examining and analyzing patient complaints for the diagnosis of pseudoarthrosis, an X-ray examination is performed.

For a more detailed examination of structural changes in bones, x-rays should be performed in two perpendicular projections.

In a number of difficult cases, the patient is assigned tomography.

When studying X-ray images with pseudoarthrosis, the following changes are revealed:

• the bone callus that connects the fragments is absent;
• fragments of the broken bone become rounded and smoothed (sometimes they become conical due to the lack of formation of bone tissue in atrophic pseudoarthrosis);
• at the ends of fragments of the bone cavity are overgrown and on them appear the end plates, stopping regeneration in the tissues of the bone marrow;
• Between the "articular surfaces" in both projections a gap is revealed;
• sometimes one of the fragments has the shape of a hemisphere resembling an articular head, and the other has a concave surface and is similar to an articular cavity.

X-ray images can reveal a false joint. To determine the intensity of bone formation and refine the form of pseudoarthrosis - hypertrophic or atrophic - a radioisotope study is performed.

Treatment

The main method of eliminating false joints is a surgical operation. Conservative therapy aimed at eliminating pseudarthritis and involving the use of medicines for the fusion of fragments and in physiotherapy does not give the expected effect.

The main goal of the treatment is to restore the continuity of the broken bone. After this, measures are taken to eliminate deformities causing damage to the affected limb. The treatment plan is made depending on the clinical case and the individual characteristics of the patient.

General and local measures are used to eliminate the false joint.

General medical measures

Patients with false joints are recommended measures aimed at increasing muscle tone, stabilization of blood circulation in pseudoarthrosis, preservation and restoration of functions of the affected leg or arms. For this, patients are prescribed physiotherapy procedures, massage and a set of exercises for physiotherapy exercises.

Local treatment

Local treatment of pseudoarthrosis implies an operation, the purpose of which is to create favorable conditions for the correct growth of fragments. To do this, their ends converge and are immobilized.

During the intervention, the surgeon pays attention not only to the rapprochement of the fragments, but also creates conditions for adequate blood circulation in the fracture region.

In addition, the prevention of infection or treatment of purulent complications.

Local treatment can be carried out according to the following methods:

• compression-distraction osteosynthesis;
• stable osteosynthesis;
• bone plastic.

The tactics of local treatment are chosen depending on the type of false joint.

With its hypertrophic form, the operation can be extra-focal - a compression-distraction apparatus is superimposed on the limb.

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And with atrophic pseudoarthrosis, in order to restore the integrity of the broken bone, we must first carry out its plastic surgery.

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When choosing a surgical procedure, the place of pseudoarthrosis localization is taken into account:

• with periarticular localization - compression-distraction osteosynthesis is performed;
• when localized on the upper or middle third of the thigh - intramedullary osteosynthesis is performed;
• when localized on the radial bone (with the development of hamstring) - first conducted a hardware distraction, and then - bone plastic;
• when localized on the brachial or tibia - performed compression-distraction osteosynthesis.

Compression-distraction osteosynthesis

This method of treatment is carried out with the help of special fragments that match the fragments. In this case, the broken arm or leg should be completely immobile.

The device allows to provide the maximum approach and mutual squeezing of the ends of the broken bone. In addition, this method makes it possible to eliminate shortening or deformation of the limbs.

After the formation of the bone callus fragments begin to gradually withdraw from each other, restoring the length of the limb and the integrity of the bone.

Stable osteosynthesis

For the implementation of this method of treatment, special fixators (plates, rods) are used, which provide the necessary contact for the adhesion and immobility of fragments of damaged bone.

For their superposition during the surgical intervention, exposure of damaged bone sites is carried out.

In hypertrophic pseudoarthrosis, bone fusion with stable osteosynthesis occurs without performing surgery for the plastic bone, but with atrophic false joints this preliminary intervention should conducted.

Bone plastic surgery

This surgical method is used infrequently, but only in cases when it is necessary to stimulate osteogenesis in atrophic pseudoarthrosis.

Before carrying out such operations, it is necessary to eliminate purulent processes, perform excision of scar changes and skin plasty.

Since the end of treatment for purulent complications, at least 8-12 months should pass before the date of the operation for bone plastic surgery.

Rehabilitation and results

Regular sessions of physiotherapy help to recover from illness.

The duration of immobilization of the affected limb with false joints is 2-3 times longer than in the treatment of the usual fracture of the same bone.

After its completion, the patient is assigned a rehabilitation program:

• massage;
• physiotherapeutic procedures;
• physiotherapy;
• Spa treatment.

Long-term prognoses of the results of rehabilitation of patients with pseudoarthrosis are favorable:

• a good result - in 72%;
• a satisfactory result - in 25%;
• a poor result is in 3%.

The appearance of a false joint is a consequence of an intrauterine pathology or a complication of an incorrect and burdened course of other diseases treated with a conventional fracture.

For the elimination of pseudoarthrosis, various surgical techniques are used to achieve normal fusion of bone fragments and to eliminate limb deformities.

To which doctor to apply

The treatment of false joints is performed by an orthopedic traumatologist.

This is a complex pathology, surgical intervention is performed in large medical centers, in which it is necessary to receive a referral at the place of residence. In this case, treatment for a patient with a medical insurance is free of charge.

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A source: https://myfamilydoctor.ru/lozhnyj-sustav-posle-pereloma-prichiny-lechenie/

False joint after fracture: treatment, surgery, causes of false joint formation

The process of bone splicing after fracture is characterized by the formation of "bone callus which is a mass that does not have clear forms and structure (high looseness).

In order to make the fusion of bones more accurate, doctors use various methods - for example, the imposition of gypsum, the use of metal plates or spokes for reliable alignment of fragments / fragments, stretching the bones of the skeleton and etc. But even with such a competent approach to the treatment of fractures, there are cases when the tubular bone simply does not grow together. The result is a smoothing of the contiguous edges of the bone and the formation of a false joint - in medicine this formation is called pseudoarthrosis.

In general, the considered complication of fractures is considered quite common - if a patient is diagnosed closed fracture of the bone, the doctors predict the development of a false joint with a probability of 5-11%, but with open - in 8-35%. Most often, the pathology under consideration takes place with a fracture of the femoral neck, a little less often - with a fracture of the radius, and if this pathology is innate in nature - on the shin.

Causes of a false joint Classification of false joints Symptoms of a false joint (pseudoarthrosis) Diagnostic measures Treatment false joint - General medical measures - Local treatment - Compression-distraction osteosynthesis - Stable osteosynthesis - Bone plastics

Causes of a false joint

The appearance of a congenital false joint is always associated with any intrauterine pathology of the fetus.

This type of the pathological condition in question is, in fact, quite rare - for 19, 00 newborns, only one case.

The reasons for the birth of a child with a false joint can be:

Acquired false joints - a common complication of fractures and their causes are clearly defined by doctors:

• the consequences of surgical interventions-for example, incorrectly performed fixation of bone fragments when there is no necessary strength of the joint, or resection thereof;
• suppurative complications of fractures;
• improper treatment of fractures - for example, the patient began to load the limb too early, or the doctor was forced several times during the treatment to change the cast;
• improperly performed immobilization of the damaged limb with gypsum, violation of the rules of skeletal traction, early removal of the apparatus for fixing fragments;
• some diseases that can lead to disruption of normal regeneration of bones and metabolism - rickets, tumor cachexia, general intoxication of the body, pathology of the endocrine system.

In addition to the foregoing, several provoking factors can also be identified, which can also lead to the appearance of the acquired false joint:

• presence of a large number of fragments / fragments of bone;
• injuries to the periosteum by medical personnel during various procedures;
• long-term use of anticoagulants or steroid medications;
• the ingress of soft tissues or foreign bodies into the gap between bone fragments;
• previously diagnosed with osteoporosis;
• inadequate reaction of the body to the devices made of metal during the metalloesteosynthesis, when the bone is fixed with plates, bolts and nails;
• obtaining additional tissue damage along with a fracture - for example, irradiation or burns;
• violation of rules for comparing the ends of a broken bone;
• absence of a bruise between the ends of a broken bone;
• clogging and closing of the bone marrow canal in fragments;
• violation of blood circulation in the area of ​​the location of fragments;
• large distance between the ends of the broken bone.

Classification of false joints

Depending on what was the provoking factor or the true cause of the condition in question, there are congenital and acquired pseudoarthrosis.

If we consider this pathology from the side of the nature of the damage, then only fire and non-fire-resistant pseudoarthroses will be isolated.

But the classification of false joints according to their clinical manifestations is more detailed:

1. Forming a false joint. Occurs at the end of the period, which is necessary for normal bone growth. Roentgen helps to identify clear boundaries of the "fracture" of the fracture and bone callus. The patient complains of constant drawing pain in the area of ​​formation of a false joint, and when trying to touch it indicates an increase in the intensity of pain.
2. Fibrous pseudarthritis. The doctor clearly diagnoses the presence of fibrous tissue located between the bone fragments, and the result of the X-ray will be a clearly defined gap between them. With such a false joint, if it is formed in the region of the joints, the mobility of the latter becomes sharply limited.
3. Necrotic false joint. It occurs often after wounds of a gunshot nature, but it can also be in fractures if there is a high probability of developing bone necrosis. Similar purulent pseudoarthrosis doctors are often diagnosed with injuries of the neck of the talant and femoral or median part of the scaphoid bone.
4. Pseudoarthritis of bone regenerate. He appears with an incorrect osteotomy of the tibia, if the doctor has violated the rules of conduct stretching or poor-quality fixation with the use of special equipment for lengthening segments.
5. The true false joint (neoarthrosis). Most often it develops on single-bone segments with excessive mobility. Similar pseudoarthrosis is characterized by the formation on the edges of bone fragments of fibrous cartilaginous tissue with areas of hyaline cartilage. Around the wreckage appears formation, which in its composition and appearance resembles a periarticular bag.

By the method of formation and intensity of bone formation, the pathological condition in question is classified as follows:

• hypertrophic false joint - bone tissue begins to expand particularly at the ends of the damaged bone;
• normotrophic false joint - no breaks are found on bone fragments;
• atrophic false joint - the lack of blood supply is clearly defined, insufficient bone formation, osteoporosis can be diagnosed.

In addition, the false joint can be uncomplicated - a condition in which there is no infection or the appearance of pus at the site of pseudoarthrosis.

But in some cases, doctors diagnose "infected pseudoarthrosis which means that a purulent infection has been associated.

In this case, the patient will have a fistula and a cavity of different sizes in the place of injury, from which the purulent contents are periodically released. Most often in such false statutes there are fragments of shells or metal locks.

Symptoms of a false joint (pseudarthritis)

The signs of the pathological condition under consideration are quite specific, therefore the diagnosis is not difficult. The most pronounced symptoms of a false joint are:

• an increase in the amplitude of movements, a change in their orientation, which can not be called characteristic of the limb;
• slightly below the fracture site, a large edema with clear boundaries is formed;
• atypical mobility of those parts of the body, in which there should not be any movement;
• changes in the functions of joints located close to the site of fracture;
• muscles of the limb lose their characteristic strength - with a false joint the patient can not squeeze fingers, raise an easy object;
• violation of the functions of the broken limb.

Diagnostic measures

A completely informative method of diagnosis in case of suspicion of false joint formation is conventional radiography. Computer tomography is extremely rare, only in the case of a severe course of fracture and an unclarified false joint.

The study of X-ray images with pseudoarthrosis helps the doctor to reveal:

• unconnected fragments, that is, the bone callus characteristic for fractures is absent;
• fragments of broken bone become rounded and smooth;
• infection and the appearance of end plates at the ends of fragments of the bone cavity, which can stop regeneration in the tissues of the bone marrow;
• a slot located between the "articular surfaces".

X-ray images allow only to identify and confirm the presence of a false joint, but to determine the degree bone formation and diagnosis of a specific form of the pathology in question, the patient will be assigned a radioisotope study.

Treatment of a false joint

The main method of treatment of the examined pathological condition is a surgical operation.

The goal of such treatment is to restore the continuity of the broken bone and then the doctors take measures to eliminate deformities.

The tactics of treatment are selected individually, because everything depends on the specific clinical case and the characteristics of the patient's body.

False joints are eliminated by therapeutic measures of general and local action.

General medical measures

By this term I mean activities that are aimed at increasing muscle tone, normalizing blood circulation directly in the place of formation of a false joint, doctors try to preserve as much as possible the functionality of the damaged lower or upper extremity. To achieve these goals, the patient is assigned various physiotherapy procedures, massage and a set of exercises for the treated gymnastics.

Local treatment

Implies the operation, the purpose of which is to create favorable conditions for the fusion of bone fragments.

During the work with the patient, the surgeon not only restores the normal shape of the bone by rapprochement and joining the fragments, but also ensures normal blood circulation in this place.

Preventive measures that are aimed at preventing infection and the development of purulent inflammation are considered to be mandatory in this case.

Local treatment is carried out according to different methods:

• bone plastic;
• compression-distraction osteosynthesis;
• stable osteosynthesis.

The specific tactics of local treatment are chosen depending on the type of false joint. For example, if it has a hypertrophic form, then a compression-distraction apparatus will simply be applied to the limb. But with atrophic pseudoarthrosis will have to carry out bone plastic surgery.

Compression-distraction osteosynthesis3

This method of treatment involves the use of special apparatus that will ensure the comparison of bone fragments.

The physician must ensure complete immobility of the injured limb and, even in this state, the use of the apparatus begins, which will approximate and combine the fragments of the bone.

It is compression-distraction osteosynthesis that helps specialists to eliminate shortening and / or deformities of the extremities.

Stable osteosynthesis

This method of treating a false joint involves the use of metal parts (plates or rods) that will ensure the fusion of damaged bone. To impose them, the surgeon will have to completely expose the bone at the site of the fracture - this operation is performed under general anesthesia.

If the patient is diagnosed with hypertrophic pseudoarthrosis, then surgery on bone plastic surgery is not required, but in case of treatment of atrophic pseudoarthrosis it is necessary.

Bone plastic surgery

Seldom, before the operation, it is necessary to eliminate any inflammatory processes and make sure there are no cicatricial changes.

If any, first purulent inflammation is cured and excision of cicatricial changes is performed.

The operation for bone plastic surgery can be performed only 8 months after the indicated treatment, but doctors usually survive 12 months.

If a false joint is treated, the affected limb should be immobilized (immobilized) for a fairly long time.

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Once the doctors are allowed to move, the patient must undergo a course of restorative therapy.

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In the framework of such a rehabilitation period, massages and courses of physiotherapy exercises, physiotherapy procedures, spa treatment can be prescribed.

In general, the result of such a complex treatment is usually excellent - in 72% of cases, patients were discharged home with fully restored functions of the injured limb.

The fake joint is a pathology that is very easy to diagnose, so doctors recommend simply going through a full course of treatment, which will be appointed by the attending physician - treatment in any case will be timely.

Tsygankova Yana Aleksandrovna, medical reviewer, therapeutist of the highest qualification category

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Causes and symptoms of false joints

Sometimes, in view of a variety of reasons, bone damage results in pathologies.

For example, a false joint after a fracture occurs in,% of cases of all injuries of the musculoskeletal system.

More than the rest of the bones, the formation of the secondary (false) joint is affected by the femoral neck and radius bones.

The formation of a false joint in the region of the lower leg

Definition of a false joint

False joint is a serious pathology, expressed in the mobility of those parts of the bone that are not anatomically predisposed to it. At the same time, the integrity of bone tissues and osteoporosis (the natural ability of bones to regenerate) are violated at the sites of formation of the secondary joint.

A defect can be congenital and acquired. At first complication after fracture very often proceeds without the expressed symptomatology, therefore medical practice in most cases is faced with severe (neglected) cases of false the joint.

Reasons for the formation of a false joint

Pathology is formed in the event that the natural restoration of bone integrity is hampered by certain factors:

• insufficient or incorrect repositioning of bone fragments;
• discrepancy of bone fragments after repositioning;
• too weak fixation of fractures with displacement or premature failure of fixing structures;
• treatment with skeletal traction (overstretch of fragments);
• too heavy loads on the area with a fracture;
• load on the limb with a fracture, burdened by displacement, until it is completely healed;
• purulent and infectious processes in the area of ​​fusion of bone fragments;
• too extensive removal of formed bone fragments;
• slowed down the process of blood circulation of the bone as a result of trauma;
• background weakness of the body: delayed metabolism, vitamin deficiency, disturbance of sleep and nutrition regimes, concomitant diseases.

Pregnancy is one of the causes of fracture failure. Since during the period of gestation the woman also changes the hormonal background and metabolic processes, the reparative regeneration of the bones can proceed without positive results.

After fracture of the femoral neck, problems often arise with the periosteum, as a result of which a false joint is also formed.

Symptoms

The already formed pathology of the false joint can be determined by visual diagnostics:

• severe curvature of the straight bone in the area of ​​injury;
• when exerting pressure on the diseased limb, the place with secondary education will be turned and come into an unnatural position, because the muscles are very weak, and the bone does not perform the supporting function.

Shoulder bone with false joint

The signs that manifest themselves during the period of pathology formation:

• minor pain during treatment (even after the average period of bone splicing);
• deformation in the area with a violation of the integrity of bone tissue;
• abnormal bone mobility;
• degradation of the muscles of the injured limb;
• minimal mobility of joints located in the niche and above the damage;
• swelling of the injured limb below the fracture region;
• limb shortening;
• On the X-ray, the displacement in the place of the incipient fracture is traced.

If a defect is formed on one bone in a two-bone system, the patient may not even guess about the development of pseudoarthrosis.

False joint or not fusing fracture

Non-growth of bone tissue according to its clinical signs resembles pseudoarthrosis, as it also proceeds with the mobility of bone fragments.

However, the false joint is distinguished by the formation of a plug closing the medullary canal, and a connective tissue, the presence of which is observed between fragments in the first half of the average term splicing.

Classifications and types of pathology

On the etiology:

• congenital;
• acquired pathological;
• acquired posttraumatic.

According to the typology of the damaging element:

• mechanical nature;
• firearm nature.

According to the clinical expression:

• Formed (observed after the maturation of bone and accompanied by the appearance of pain during palpation and in dynamics; on the X-ray you can see a characteristic gap in the place of fracture and periosteal corn);
• fibrous (account for the period of the formation of a fibrous substance filling the gap at the site of the fracture);
• necrotic (it is formed as a result of a gunshot wound, but it can also form if the victim has a tendency to bone necrosis);
• pseudoarthrosis of bone regenerate (is the result of incorrectly provided medical care when excessive stretching of the limb, insufficient fixation or removal of chopped segments, violating the anatomical structure bones);
• the true false joint (typical for the one-bone sections of the limbs in pathologically moving places; The splinter ends of bones are ground, after which the cartilage is formed on them, and the gap is filled with the joint liquid.

By activity of formation of bone tissues:

• hypertrophic (if the limb is a constant reference pressure or surrounding the vascular network has not lost its functions, the damaged parts of the bone begin to regenerate and expand);
• avascular (if the vessels were damaged, and the bones do not show tendencies to growth, an avascular deviation is diagnosed).

By the presence of inflammation:

• suppuration;
• infection;
• purulent infections (provoked by those present at the site of damage by foreign bodies or fistula with purulent contents).

Diagnostics

What is the diagnosis of a false joint? First of all, this is a visual analysis of the patient's condition. The attending physician examines the injury site, determines the time of injury (in order to determine if the median period of adhesion has passed), and makes a clinical picture.

Treatment

A false joint can be treated with a conservative method, with the help of special medicines and electrostimulation. But these methods are used only at the initial stage of pathology formation.

If the secondary joint has already taken shape, surgical intervention is required. It consists in osteosynthesis in combination with the plasticity of bones.

bonding bones

The principles of surgical treatment of a false joint are as follows:

• is performed no earlier than six months or a year after the injury has been healed;
• with a fracture of the femoral neck, the support axis is restored, in order to prevent the development of lameness;
• bone fragments are matched as accurately as possible to prevent relapse;
• the ends of the bone fragments are subjected to the refreshing procedure (hypertrophied bony growths are removed), the restoration of the tubules and excision of the scar tissue).

The most common methods of surgical treatment are the methods of Chaklin and osteosynthesis of transplants.

Prevention

Unfortunately, it is impossible to prevent the formation of a false joint. The only effective method of preventing and simultaneously treating the acquired defects of bone tissue is correct medical care, which is manifested in the fixation of fractures.

Strictly forbidden to remove gypsum before the due date, so as not to provoke excessive load leading to the formation of a secondary joint.

The maintenance of body immunity also helps to avoid deviations in fracture fusion, since the immune system affects the regenerative capacity of body tissues.

A source: https://PerelomaNet.ru/perelomy/lozhnyj-sustav.html

False joint after fracture: what is it, causes, symptoms, signs, treatment

A false joint or pseudoarthrosis develops as a result of an incorrect fusion of bone fragments during a fracture.

Under normal circumstances, after fracture, the bone is healed by forming a compliant, shapeless bone tissue.

It helps to consolidate 2 fragments of bone and restore its integrity.

In medicine, many special treatment methods are used, for example, impose gypsum, fragments of bones are joined at help of metal plates, perform the extraction of the skeleton and other manipulations for proper bone growth fracture. But in the event that bone fragments due to some cause do not grow properly, after some time the edges of the bones that contact each other are rubbed and smooth. This is how the false joint is formed. Sometimes there is a development of a thin layer of cartilaginous tissues on the surface of debris that come into contact, or accumulation of fluid. Often observed the formation of a certain articular bag around the pathological coalescence.

Classification of false joints

Such anomalous fissures are divided into several categories: congenital, traumatic and pathological. Relying on the clinical and radiological picture, we can distinguish:

1. The false joint that forms. It develops after a period of bone fusion. Features of such pathology are: pain syndrome in the fracture site, pain during palpation and motor activity. Radiography shows a specific lumen of the fracture and periosteal callus.
2. Fibrous false joint - a dense fibrous tissue appears between the bone fragments, the joints move normally, but the X-ray shows a narrow gap after the fracture.
3. A fake joint of a necrotic nature occurs with gunshot injuries. At the same time, blood circulation is disturbed. Either it can occur after a fracture, if there is a predisposition of the bones to the formation of necrosis.
4. False joint of bone regenerate - this is an abnormal formation, appears as a result of osteotomy due to excessive stretching or incorrect fixation when performing medical manipulations on lengthening segments.
5. The true false joint is formed mainly on the one-bone segments in places of pathological mobility. There is a grinding of bone fragments, soon they are covered with fibrous cartilaginous tissue from above, a gap appears between them, in which the accumulation of liquid takes place. Near the ends of the debris is formed a cavity with defective contents.

According to the presence of infections and pus, they share false joints of uncomplicated character and infected pathological formations.

Based on the stage of osteogenic activity, they share:

1. Hypertrophic formations - in this form, bone tissue grows at the ends of the fragments.

   This phenomenon occurs in people with constant pressure on the limb or with reduced motor activity of fragments of bones.

2. Avascular false formations - with this form in the joints blood circulation is disrupted, a disturbance in bone formation is visualized, osteoporosis of debris is formed.

Why is his education going on?

The main causes of pseudoarthrosis, which provoke the appearance of pathological fusion, are diseases accompanied by disruptions in metabolism (diseases of the endocrine system, oncological ailments), complications after surgical intervention (unstable fixation), incorrect management of postoperative therapy (early loads on the limb, earlier removal clamps). Another factor in the development of pathology are errors in drug therapy, purulent formations. The reasons for the formation of pathology are as follows:

• disturbance of blood circulation in the site of fragments;
• increased lumen between fragments;
• penetration into the lumen between fragments of soft tissue;
• The wrong location of the fragments after comparing the bones touching each other.

There are other reasons for the appearance of pseudoarthrosis:

• osteoporosis;
• damage to bone tissue during surgical treatment;
• absence of clot formation between fragments;
• reaction of the organism to metal fixation devices;
• the presence of an alien body between the fragments;
• excessive amount of fragments;
• reaction to taking certain medications after the fracture (hormones, anticoagulants);
• The presence of any other tissue trauma (burns).

Symptomatology of the disease

The main symptoms and signs of the appearance of pathology is the excessive mobility of some joints, which, under normal development, should not move this way. This phenomenon is almost imperceptible, or, on the contrary, intensely pronounced.

For example, there are cases in medical practice when a sick person managed to turn a limb 360 degrees in those areas where pseudoarthrosis was formed.

There are changes in the muscular strength of the joint, shortening of the limb up to a few centimeters is diagnosed.

1. Russian Medical Journal - http://www.rmj.ru/; 2. The journal "Consilium Medikum" http://con-med.ru/; 3. The journal "The attending physician" http://www.lvrach.ru/; 4. Journal of Neurology and Psychiatry. FROM. FROM. Korsakov; 5. Journal of Scientific and Practical Rheumatology; 6. Electronic Journal "Angiology" - http://www.angiologia.ru/; 7. JOURNAL "ANGIOLOGY AND VASCULAR SURGERY 8. Journal of Phlebology; 9. Directory of medications Vidal - http://www.vidal.ru/;

10. Directory of medicines Radar - http://www.rlsnet.ru/;

A source: http://legsgo.ru/trauma-surgery/fractures/lozhnyj-sustav.html