Signs of an improperly fused bone
The main symptoms that the bone has not healed properly:
- angular or rotational deformity of the bone,
- shortening of the limb,
- muscle atrophy,
- pain when moving.
In case of a fracture of the bones of the upper and lower extremities, pain is present not only around the injured area, but also in the nearest joint.
To fully restore the impaired functions of the injured limb, you should immediately begin treatment and consult an orthopedic traumatologist. For this purpose, we recommend that you contact the KIT multidisciplinary medical center, where we will conduct diagnostics and do everything possible for your speedy recovery.
Recovery after surgery
On the first day after surgery, specialists at clinicamalyshevoy.ru recommend staying in the hospital under observation. Then the rehabilitation period begins, which lasts at least one and a half months.
In order for the treatment to have the maximum effect, the patient should come for regular examinations so that the doctor can observe and control the process of bone fusion.
If all medical recommendations are followed, a person will be able to minimize the load on the bone and avoid its repeated deformation.
Improper healing of fractures is one of the most common complications of limb injuries that clinic doctors constantly encounter.
The hospital employs exclusively highly qualified experienced surgeons who can cope with fractures of any complexity. Manipulations are carried out only on the most modern equipment that has passed the necessary certification and meets international quality standards.
Anesthesiologists, surgeons, nurses, radiologists and other clinic specialists taking part in treatment are distinguished by their professionalism.
If your fractures have not healed properly, seek advice. The doctor will conduct an examination, develop and prescribe the necessary treatment regimen individually.
Possible pathologies
Improper healing of a fracture can cause the following pathological phenomena:
- Post-traumatic synostosis is the soldering of more than 4 bone fragments.
- Fibrous fusion of the ends of bone fragments - they are connected by a layer of fibrous tissue, compacted, but do not have end plates; this condition can only be determined using x-rays.
- Pseudoarthrosis (false arthrosis) - each fragment is separated by its own end plate; due to impaired blood supply to the ends of the fragments, bone necrosis may occur: Fibrous pseudoarthrosis is characterized by the free movement of fragments in the soft tissues.
- Neoarthrosis is accompanied by the formation of fibrous cartilage at the ends of the fragments and the presence of separate end plates.
- A defect of part of the bone is a condition in which the fragments are located at a distance from each other and can move freely in different directions.
Reconstruction of fractures: price in Moscow
At Elena Malysheva’s clinic you can perform surgery at very reasonable prices. Our patients come from all over Russia, the CIS countries and Europe, we are ready to offer optimal conditions for the full course of treatment.
The price for reconstruction of bones and joints (with osteotomy or plastic surgery) is 208,000 rubles.
You should not put off taking care of your health for a long time; timely treatment will help you quickly return to your normal life.
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Treatment of improperly fused bones
To begin with, we will conduct a thorough examination and research that will help determine the type of deformation. This may require:
- radiography,
- study of nerve conduction,
- vascular examination,
- hospital screening (a standard set of tests to determine the patient’s condition).
Treatment of diaphyseal fracture
The most common cases with which patients come to us are the consequences of diaphyseal fractures (in the middle of the bone). This pathology can only be treated with surgery.
The fracture site is opened and the fragments are reassembled. At the joints, the doctor makes special incisions that accelerate the regeneration of bone tissue.
If the fragments have clear edges and can be compared, we use intraosseous fixation using a metal pin/rod (this is called osteosynthesis) and autoplasty. The material for grafts is the ilium.
In cases of severe bone deformation after incorrect healing of a fracture, we try to reduce the risk of neurological disorders, since the deformed bone puts pressure on the neurovascular bundle and causes fibrotic changes in the muscles. In such situations, a partial resection is often necessary, in which part of the bone is removed. Our specialists have extensive experience in carrying out such operations. An action plan is thought out in advance, taking into account the patient’s research results. It is important to know exactly the location of nerves, blood vessels, and the physical characteristics of the patient’s muscle tissue.
If the fracture is still relatively fresh, closed bone refracture may be performed. It breaks again, after which a cast is applied or permanent skeletal traction is done. The surgical intervention is performed under anesthesia, so the patient does not feel any pain.
Treatment of intra-articular fracture
Cases of intra-articular fractures also require surgical treatment. To restore the bone, osteotomy, resection, endoprosthetics, and other osteoplastic operations are performed. If it is necessary to use an implant, selection is made on an individual basis, taking into account the physiological characteristics of the patient. Often, such fractures require bone grafting: the deformed area is replaced with bone tissue.
We pay special attention to treating the consequences of improper treatment of intra-articular fractures in children. Lack of timely professional medical assistance can lead to increased deformity with age. This will cause limited mobility and reduced functionality of the joints.
Intra-articular fractures and their incorrect treatment are dangerous because over time, severe arthrosis develops in the fused joint. This often happens even to young patients who do not feel any discomfort for several years.
Osteotomy
Incorrect healing of bones after a fracture is corrected using a corrective osteotomy. This operation is performed under general anesthesia , as an independent surgical intervention, or as one of the stages of another serious operation.
Its purpose is to eliminate the resulting bone deformation.
To do this, during the operation, the incorrectly fused bone is broken again or cut with a laser, radio wave energy, or traditional surgical instruments.
The resulting bone fragments are connected to each other in a new, correct position using knitting needles, screws, plates or special devices.
During the operation, the principle of skeletal traction , when a load is suspended from a pin placed in the bone, due to which the bone is stretched and takes the position necessary for normal fusion.
Depending on the type of osteotomy, there are:
- Open , during which the surgeon makes a 10-12 centimeter skin incision that exposes the bone, separates the periosteum from the bone and dissects the bone. In some cases, the bone is cut through pre-drilled holes.
- Closed , when the skin at the site of injury is cut only 2-3 centimeters, then with the help of a surgical instrument the bone is cut to approximately ¾ of its thickness, then the remaining uncut portion of the bone is broken.
During a closed-type osteotomy, nerves and large vessels can be seriously damaged, so to straighten bones when they are not fused properly, an open-type osteotomy is usually used!
Most often, they operate on the bones of the upper or lower extremities in order to restore to them the normal functionality lost due to fractures and improper fusion.
Thanks to osteotomy, the patient’s legs are returned to the position necessary for movement, and the arms are returned to perform their anatomically inherent movements.
Osteotomy cannot be done if:
- Cardiovascular pathologies.
- Severe diseases of the liver, kidneys and other internal organs.
- Exacerbation of chronic or acute diseases.
- Purulent infection of tissues or organs.
Like any surgical intervention, osteotomy is dangerous due to the following possible complications:
- Displacement of bone fragments.
- The occurrence of a false joint.
- Infection of a postoperative wound, up to suppuration.
- Slowing down the process of bone fusion.
Nonunion, false joint
Any of the methods of treating false joints, conservative or surgical, has its advantages and disadvantages. You should always consider multiple treatment options and discuss with your doctor the possible benefits and risks of treatment in your individual case. After carefully weighing these risks and benefits, your doctor will recommend the treatment option that is best for you.
Conservative treatment
Some false joints of bones can be treated conservatively, but most often such treatment is ineffective.
Surgery
Surgical treatment is indicated in cases where conservative treatment is ineffective.
Also, surgery may be indicated in cases where one operation has already been performed, but also turned out to be ineffective.
Surgical treatment options include bone grafting, bone grafting, internal and/or external fixation.
- Bone grafting . This operation uses the patient's own bone tissue, which is taken from one place and moved to the area of the pseudarthrosis to stimulate the healing process. This bone tissue serves as a kind of matrix for the formation of new bone tissue. Also, this bone tissue is a source of fresh cellular elements and biologically active substances necessary for the normal process of bone fusion.
During such an operation, the surgeon makes additional access to the area of another bone, most often in the area of the pelvic bone (“iliac crest”), where the required number of bone fragments is taken. This additional surgical approach can be quite painful, but there are usually no other functional or cosmetic problems associated with it.
During bone grafting, bone is taken from the posterior part of the iliac crest and moved to a previously prepared area of the pseudarthrosis.
- Alloplasty (plasty with cadaveric bone) . Alloplasty avoids additional intervention associated with the removal of the patient’s own bone, and from this point of view, it is more optimal for a patient who does not want to experience additional problems. Like conventional bone grafting, alloplasty promotes the formation of a bone matrix in the area of the pseudarthrosis, along which new bone will grow. Over time, the allobone will be completely replaced by the person’s own bone. There is a potential risk of transmission of infections with alloplasty, but cadaveric bone is properly processed and sterilized before it is used as a plastic material, so this risk really only exists in theory.
- Bone substitutes or osteobiological preparations . Like alloplasty, the use of bone substitutes avoids additional bone harvesting and possible associated problems. Bone substitutes are not a source of fresh cellular elements, but they may contain biologically active substances necessary for the growth of bone tissue.
Depending on the nature of the pseudarthrosis, any of the materials described above can be used for plastic surgery in any combination with each other.
Bone grafts (or bone substitutes) by themselves do not provide stabilization of bone fragments, therefore, if the area of the pseudarthrosis does not have the necessary stability, its stabilization through internal or external fixation is indicated.
- Internal fixation . This method allows you to stabilize bone fragments and involves the use of special screws and plates fixed along the outer surface of the bones, or intraosseous rods that are inserted into the medullary canal inside the bone.
If a pseudarthrosis occurs after surgical treatment of a fracture, when internal fixation of the fragments has already been performed, it may be necessary to change the internal fixation option to increase the stability of the fragments. In such cases, the surgeon may prefer a more rigid design, such as a larger diameter rod or longer plate. Removal of the previously installed rod, subsequent reaming of the medullary canal and installation of a larger diameter rod increases the stability of fixation and stimulates bone fusion. Internal fixation can be combined with any bone grafting option.
- External fixation . This is another method of stabilizing damaged bones, which involves connecting the bone to a rigid external fixation device using pins or threaded rods. External fixation can be used in cases where one of the reasons for the formation of a false joint is the lack of proper stability of bone fragments. The method is also used in patients with bone deficiency and/or infection in the area of the pseudarthrosis.
Schematic illustration of an external fixator fixing the pseudarthrosis of the tibia.