- False joints - when the mobility of broken bones
- Why are there
What is a false joint
False joint - a persistent breach of continuity and mobility of bone, it is not specific to the department. Nearthroses divided into congenital and acquired. Congenital false joints are relatively rare, their predominant localization - the lower third of the leg, but there are isolated congenital false joints collarbone, elbow and thigh bones.
The acquired false joints represent about 3% of all orthopedic diseases. More than 95% of them occur after traumatic fractures - closed, open and gunshot, the other - after the pathological fractures and various operations on the bones. The most frequent localization of acquired false joints - the tibia and femur neck, rarer false joints of bones of the forearm, shoulder, thigh, wrist bones, the clavicle, the patella.
The acquired false joints may be of various types - from the barely visible on the radiograph of the gap between the fragments of bone with very little mobility to their great distance between the fragments filled with connective tissue, with significant mobility of bone fragments.
Why are there
At the heart of congenital pseudoarthrosis is a violation of intrauterine bone formation with the occurrence of defective bone structure in a particular area, leading to disruption of the integrity of the bones after the start of the load (usually 2-3 years).
The emergence of acquired false joints due to a variety of general and local factors. The common factor is accepted to impaired function of the endocrine glands, pregnancy, deficiency diseases, acute and chronic infectious diseases, various disorders of the nervous system. Local causes formation of false joints have a leading role, they are divided into several groups:
- Group I - causes related to medication errors - not fully ratio of fragments, incomplete removal of the fragments of soft tissue clamped, improper immobilization, and so on;
- Group II - reasons related to the severity of injuries and trauma caused by complications - the loss of a significant part of the bone in trauma or surgical intervention, crushing muscles at a considerable distance from the exposure of bone, soft tissue abscess, and bone, and so on;
- Group III - causes related to anatomical and physiological characteristics of blood supply to the bone fracture and localization (for example, circulatory disorders of the bone fragments associated with the peculiarities of its structure).
In the formation of nonunion of great importance in the field of circulatory disorders fracture that causes a change in bone formation and decrease in strength of callus, until complete disengagement fragments. Prolonged mobility can lead to transformation of bone fracture zone in the first fibrous (connective tissue), and then into the cartilage - i.e. the formation of nonunion.
Signs of nonunion
When false joints observed abnormal mobility in the field. If there is no load on the limb pain in nonunion or she is not insignificant. This is different from the false joint ununited fractures in which mobility is negligible and there is always a pain. The formation of a false joint symptoms usually occurs within a period equal to twice the medium term fusion fragments. Until then, the pathology treated as ununited fracture.
The deformations in the acquired false joints can be very different, but they are typical of certain locations. Thus, when the femur pseudoarthrosis deformation characteristic as a "breeches". For congenital tibia nonunion characteristic angular deformation of the lower third of the leg with an angle open posteriorly.
Shortening of limb segment under false joints may be different. In the formation of a false joint in childhood shortening is always more. Pathological mobility, deformation and shortening and define the main functional disorders. For the lower extremities - a violation of reference, forcing the patient to use the additional support (eg crutches). For the upper extremities - the weakening of muscle strength. Over time, changes occur in all tissues of the affected limb.
Diagnosis and treatment of false joints
Diagnosis is based on characteristic symptoms of the disease and is confirmed by X-ray studies.
The goals of treatment include restoring the continuity of the bone and the removal of existing strains to return to the normal function of the limb. Treatment consists of general and local events.
General therapeutic measures designed to strengthen the body, increase muscle tone, preservation and restoration of joint function of the damaged limb, restore blood circulation in the area of nonunion. This specially selected courses of medical gymnastics, massage, physiotherapy.
Local treatment operative, it is to create conditions for normal bone recovery by convergence and immobilization of bone fragments, the treatment of disorders (including suppuration) in the area of soft tissue.
In general, modern methods of treatment of false joints allow to receive more than 95% of positive outcomes.