Faulty healing and pseudarthrosis – treatment

Faulty healings with slight malalignment and without symptoms do not require therapy. However, if the function is impaired or is expected to be impaired in the near future, a corrective osteotomy can be performed.

Procedure

In a corrective osteotomy, the mishealed bone is cut again and fixed in the correct position with screws/plates. Sometimes additional bone is needed to restore the original shape of the bone. This can be taken from the iliac crest, for example.

If a pseudarthrosis is very tight and the overall shape of the bone is not severely altered, it may be painless or have few symptoms. In these cases, therapy is not necessarily required, even if the bone is not expected to heal completely at some point. However, if symptoms persist, surgery is usually necessary. The connective tissue between the bone ends is removed and the bone, which is often no longer of good quality directly at the former fracture edge, is shortened back to a healthy state. This often results in considerable tissue loss, which has to be filled with bone, for example from the iliac crest. Finally, the bone is screwed and plated again. If there is also an infection in the bone, all infected tissue must first be removed and the infection cleaned up. The reconstruction of the bone as described above is then usually carried out in a second operation. In the meantime, the bone is temporarily stabilized, for example with an external fixator.

Aftercare

Follow-up treatment is similar to that after surgical fracture treatment. Adjacent joints are moved as early as possible without stress. In most cases, no circular plaster cast is required, only splints that can be removed for therapy in between. Ideally, bone healing does not take longer than with a fresh fracture (six to eight weeks, depending on the location), but is usually longer with infectious pseudarthrosis.

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