Faulty healing and pseudarthrosis: causes and risk factors
The causes of incorrect healing can be a loss of correction that occurs during bone healing or an initial treatment in the wrong position. The main causes of loss of correction are poor bone quality, comminuted fractures with many fragments, screws/plates that are too weak or excessive loading during the bone healing phase.
The main causes for the formation of pseudarthrosis are poor blood supply to the bone, too stable or too weak fixation of the fracture or bone infections. Open fractures in particular have an increased risk of bone infections.
Symptoms: Visible misalignments and load-dependent pain
Depending on the localization (e.g. long bones), visible malpositions can occur in the case of incorrect healing. The misalignment can lead to restricted movement (e.g. turning movement in the case of misalignment in the forearm area) and to incorrect loading in joints with the corresponding risk of premature wear and tear of the joint (osteoarthritis). Depending on the extent of the deformity, pain may also occur during exercise or movement.
Pseudarthrosis often leads to pain in the affected area as a result of strain. There is often no pain at rest. If there is also a chronic infection of the bone, relapses often occur with redness, swelling and pain in the affected area and the formation of ducts that lead from the bone to the surface of the skin and through which pus escapes.
Faulty healing and pseudarthrosis: diagnosis with us
The medical history and clinical examination lead to a suspected diagnosis. Faulty healing is usually visible on x-rays. Computed tomography scans of the affected and healthy limbs are often carried out in order to quantify the deformity precisely and plan a correction. This allows a direct comparison of healthy and diseased and thus a very precise planning of a reconstruction operation.
X-rays are also the diagnostic method of choice for pseudarthrosis. In the case of infections, MRI or scintigraphy are sometimes used to better assess the vitality of the bone and the extent of the infection. Furthermore, a tissue sample is usually taken in order to identify the pathogen causing the infection and to be able to carry out targeted antibiotic therapy.
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.