A false joint or pseudarthrosis is actually a section of bone formed after an injury as a result of incorrect fusion of fragments with unusual continuity, which is characterized by the appearance of pathological mobility in this section. Pseudarthrosis after a fracture is diagnosed in approximately three percent of clinical cases. Less commonly, pseudarthrosis is congenital.
Most often, traumatologists have to deal with pseudoarthrotic formations on the radius, tibia or ulna. Sometimes in clinical practice there are also false joints of the femur (femoral neck), false joints of the rib, and other tubular bones. If such a pathological connection cannot be corrected, over time it will transform into more complex pathologies and sooner or later will cause a person’s disability.
Causes of formation of false joints
The formation of a false joint during a fracture is associated with a disruption of the process of normal bone fusion, when the defect between its fragments is replaced by connective tissue with an altered structure. Among the most common causes of this pathological condition, experts identify:
- the distance of bone fragments from each other, which prevents their normal fusion;
- bone chips falling between the two broken ends of a bone;
- placing increased intensity loads on the bone during the formation of callus;
- suppuration at the site of a bone fracture or impaired blood circulation.
Frequent causes of pseudarthrosis during conservative treatment of fractures are decisions to remove the plaster cast prematurely. Sometimes the cause of the formation of pseudarthrosis is nerve damage, diseases of the endocrine organs, deterioration of calcium absorption, metabolic problems, severe blood loss during a fracture, or shock conditions.
Danger of condition
Acquired false joints are parts of bone, the space between which is filled with connective tissue. After some time, the ends of the fragments will become covered with cartilage and become more mobile. Articular cavities will form in the area of the voids. They will be filled with synovial fluid. If the pathology is congenital, then there is bone tissue that is only partially formed.
Detecting the problem is not so easy: the symptoms are mild or may be completely absent. Congenital pseudarthrosis is detected when the baby learns to walk. Acquired forms where there was a fracture. Palpation is usually painless, but loading causes pain.
Why is a false joint dangerous? Its fragility, inability to withstand the usual loads, which is fraught with repeated fractures.
Signs of a pseudarthrosis
All types of false joints are characterized by the presence of a common sign of pathology - unusual mobility in a certain area of the bone. Symptoms in the acquired form of the disease are mild or may be absent altogether until the false joint of the bone develops consequences.
In addition to pathological mobility, the formation of a false joint during a fracture is accompanied by the appearance of pain under axial loads on the damaged bone. The congenital variant of pseudarthrosis makes itself felt as soon as the child begins to walk. This pathological condition interferes with the normal development of the baby and has a more pronounced clinical picture than post-traumatic disorder.
What may be the symptoms of TMJ dysfunction?
- Tenderness or pain in the area of one or both TMJs at rest or when opening the mouth.
- Crunching, clicking, crepitation and other noises in the area of one or both TMJs when opening the mouth.
- History of TMJ injuries (previous), incl. dislocation, subluxation, chronic subluxation.
- Restrictions in the mobility of the TMJ, restrictions in opening the mouth.
- Excessive tone of the masticatory muscles, bruxism (“grinding” of teeth in sleep, at rest).
- Asymmetry of the chin, lips, lip frenulum, asymmetry of mouth opening, S-shaped opening.
- Suspicion of a forced position of the lower jaw.
Structure of the TMJ
The presence of one or more of the above symptoms may indicate TMJ dysfunction.
Traditional orthodontic treatment does not address TMJ dysfunction. During orthodontic treatment, the severity of dysfunction may not change, decrease or increase. At the moment, in the world scientific orthodontic literature there is no convincing data on the connection between orthodontic treatment and the condition of TMJ. Deterioration of the joint after treatment may have nothing to do with this treatment.
Note! Even in the absence of visible clinical manifestations of joint dysfunction, hidden disorders may occur that require special diagnostics to identify them.
If there is a forced incorrect position of the lower jaw, its position may change during the treatment process with changes and complication of the treatment plan (the need to remove individual teeth, increasing the duration of treatment). A reliably forced position cannot be diagnosed by traditional orthodontic methods; to verify its presence, as a rule, a special analysis is required (manual functional analysis, determination of the central relationship of the jaws), the use of a special articular splint for a period of several months, which, however, does not give 100 % guarantees.
To conduct a detailed articular diagnosis, explain the specifics of your case, and further manufacture an articular splint, you can make an appointment with an orthodontist who deals with the issue of TMJ dysfunction.
TMJ dysfunction is a chronic condition that can be compensated, but not cured (i.e., it is possible to eliminate symptoms, however, pathological changes in the joints, if they have already occurred, will most likely persist).
Diagnostics
When making a diagnosis, the doctor is guided by the clinical examination of the patient and the presence of the main symptoms of pseudarthrosis or complications of a pseudarthrosis. Pathology can be confirmed by X-ray examination, during which the following is determined:
- absence of callus, which should connect bone fragments;
- fusion of the bone marrow cavity;
- smoothing the ends of bone fragments.
In doubtful clinical cases, the specialist may suggest that the patient do a computed tomography scan at the site of the suspected development of a pseudarthrosis.
What happens if TMJ dysfunction is not treated?
If the dysfunction is not treated, the compensatory capabilities of the body may sooner or later be exhausted, the symptoms will worsen, the pathology will begin to progress, causing greater discomfort (sometimes for several years), thereby affecting the deterioration of the function of the dental system.
In order to try to prevent this and carry out treatment taking into account the individual characteristics of the structure and functioning of the temporomandibular joints, patients are usually offered the following approach.
Treatment of pseudarthrosis in Naberezhnye Chelny
Treatment of a pseudarthrosis should be carried out exclusively by an experienced and qualified specialist after a competent diagnosis of the pathological condition. Therefore, if you suspect a problem at the site of a former fracture, you must contact a competent orthopedic traumatologist who can recognize pseudarthrosis and prescribe the patient the necessary examinations to confirm the diagnosis.
Today, for the effective treatment of false joints of bones, surgical techniques are used using Ilizarov apparatuses for intensive osteosynthesis of the damaged area. If such a technique does not bring the expected result, then doctors resort to bone grafting as a more complex method of treating pseudarthrosis.
In the case of a congenital defect, children are prescribed surgical correction or a set of physiotherapeutic procedures. More detailed information about physiotherapeutic treatment of pseudarthrosis can be found here.
Treatment
The method of surgical treatment is selected based on the results obtained from x-ray examination. In some cases, there are contraindications to surgical intervention, then conservative treatment is carried out using special support devices, massage, and physiotherapy. In addition to the general condition of the patient, the time that has passed since the day of the fracture is also taken into account, whether the femoral head is viable, what part of the neck remains intact, and how significantly the greater trochanter and diaphysis of the femur have shifted upward.
Surgical treatment comes down to several options:
- Reconstruction using autograft . This method is suitable for people who have preserved the femoral head, minor destruction of the femoral neck, and a slightly upward displacement of the greater trochanter. During the operation, the fragments are freed from fibrous formations, the surfaces of the bone fragments are “refreshed” by cleaning. Next, a rod that performs a conductive function is threaded through the greater trochanter, the fragments are reduced, and the wire is advanced into the femoral head. The position of the rod is determined using x-rays. The graft is taken from the tibia and, using a pre-made tunnel, is passed through the trochanter, neck and head. The joint is fixed for 2-3 months. If the fusion is successful, then further restoration occurs with the help of an orthopedic device. After six months, it is possible to use the operated leg.
- Open reduction , intra-articular osteosynthesis using a nail. During the operation, the capsule is incised, all scar tissue is removed, the fragments are combined and fixed with a three-blade nail. If necessary, additional traction with a wire is applied, and bone grafts are used. Elderly patients often have to create an artificial ankylosis by driving the nail through the head of the joint and the acetabular cup.
- Reconstructive surgery . It is used for complete resorption of the femoral neck, destruction of the head and significant displacement of bone fragments. In this case, the neck and also the head are recreated by transplanting cartilage to the trochanteric end, the femur, and the remaining part of the neck. During the reconstruction process, metal caps and other devices are used.
In some cases, the above methods are ineffective, the fusion process does not occur, and inflammation and suppuration begin.
Especially if the operation was performed on an elderly person, when slowed metabolic processes no longer provide nutrition to the joints and bones. The issue is resolved by hip replacement. After which the patient’s normal mobility is restored. Modern implant models reduce the risk of inflammation and rejection to a minimum. Not all clinics can guarantee a positive result from endoprosthetics, especially when it comes to older people. In Europe, the percentage of successful operations is very high, so many who have the opportunity seek treatment there. The best combination of price and quality is the Czech Republic. , which has long-term strong ties with leading orthopedic clinics in this country, organizes treatment and rehabilitation for patients from the Russian Federation. Reviews after endoprosthetics speak for themselves.
Rehabilitation
Rehabilitation after surgical treatment of false joints is recommended to begin within a few days after surgical correction. To prevent the formation of contractures, the patient is prescribed an individual complex of physical therapy using the most effective exercises in this case. Magnetic therapy, UHF and other physiotherapeutic procedures have a good effect on the process of normal healing of the defect and restoration of bone structure.
The clinic of restorative medicine in Naberezhnye Chelny employs professional doctors who are able to provide a truly effective range of services to eliminate problems with false joints of bones. Our specialists are known for their attentive attitude towards patients, extensive experience in the field of traumatology and rehabilitation, and the use of exclusively modern and effective techniques.
All information about the cost of treatment can be found by following the link, by calling +7 (8552) 78-09-35, +7 (953) 482-66-62 or by visiting the clinic in person.
Clinical manifestations
The symptoms of pseudarthrosis of this localization can be vague. Patients can even walk on crutches. Externally, noteworthy:
- Shortening of the leg from 1 to 5 cm or more.
- Deformation of the injured limb.
- Impaired limb support.
- Atrophy of regional muscles (gluteal, femoral).
The professionalism of doctors, the modern equipment of the orthopedic department of our clinic and an individual approach to each patient help to identify pseudarthrosis in the early stages and apply the necessary method of surgical treatment (osteosynthesis or endoprosthetics).
When adjacent departments are not affected, restoring health is much easier.