The Hip: Preservation, Replacement and Revision

Pseudoarthrosis of the Tibia



- See: Congenital Pseudarthrosis of Tibia

- Classification into "Stiff" and "Lax" Pseudoarthrosis:
    - stiff pseudoarthrosis:
         - bone ends are hypertrophic
         - hypertrophic non union should first be compressed for 2-3 weeks, followed by gradual distraction;

- Lax Non Union:
    - lax nonunion of tibia is often equated w/ synovial pseudoarthrosis;
    - type I:
         - pseudoarthrosis with osteopenia at bone ends;
         - after resection of lax pseudoarthrosis iniate compression for 2 weeks, & then follow w/ gradual distraction osteogenesis;
    - type II:
         - pseudoarthrosis w/ bone ends that are sclerotic for 1-2 cm
         - w/ sclerotic bone ends, then osteogenic reparative process, is impaired;
         - sclerotic bone ends will defy attempts of healing w/ compression and distraction osteogenesis;

- Treatment:
    - synovial pseudoarthrosis should not be treated w/ electrical current to stimulate osteogenesis;
    - should be treated w/ resection of pseudoarthrosis, bone grafting,  & rigid internal or exernal fixation;
    - if skin coverage is poor, a local soft tissue flap or vascularized free flap may be necessary to achieve union;
    - if frx is in good alignment w/ stable fibrous union, autogenous cancellous bone grafting packed around frx site in vascular soft tissue bed may obtain union;
    - w/ Ilizarov, pseudoarthrosis may be treated w/ compression for 2 to 3 weeks which creates stability and crushes fibrous and fibrocartilaginous tissues between the bone ends;
          - consider resecting tibial non union & then beginning compression-distraction;
                - compression of non union site is done simultaneously as distraction of the corticotomy site;
          - once bone contact is obtained, compression of the non union is performed;
          - if there is less than 2 cm of shortening after synovial pseudoarthrosis, then begin compression for 2 to 3 weeks, followed by gradual distraction;
          - need for stability:
                - w/ insufficient stability tissues may fail to ossify & will rather go thru a cartilagenous stage;
                - w/ addition of rings and tranfixation wires, stability is enhanced which tends to enhance ossifcation



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Wednesday, August 1, 2012 1:26 pm