False joint: description, diagnosis and treatment
Various pathologies of the musculoskeletal system occur frequently. The most common are fractures, sprains, bruises. Some of them pass without leaving marks, others lead to various, sometimes very serious complications and health problems. Many of the fractures result in the formation of false joints. In this article we will understand what it is, and also consider the main methods of treatment of the disease.
A false joint is a pathological condition in which the continuity of the tubular bone is disturbed, and mobility occurs in uncharacteristic regions. The disease can be congenital and acquired (post-traumatic). Usually, symptoms are mild, there is unusual mobility and pain when resting on the damaged surface. The main diagnostic method is x-ray. Therapy is surgery. Let us consider in more detail the pathology of a false joint.
ICD code 10:
- M84.1 Failure of the fracture (pseudoarthrosis).
- M96.0 Pseudarthrosis after fusion or arthrodesis.
Description of the disease
After a bone fracture, a “callus” is formed, due to which healing takes place. A loose and shapeless tissue appears that squeezes between two bone fragments. As a result, bone integrity is restored. For better healing, there are special medical techniques:
- the imposition of gypsum;
- connecting debris with metal plates (osteosynthesis);
- traction of the skeleton.
When the bone fragments fail to grow, for any reason, contact of the bone edges and their rubbing occurs. The edges are smoothed and form a false joint. On the surface of the fragments that are in contact with each other, a thin layer of cartilage tissue and fluid appears. This is the way the real joint works. The false joint surrounds the articular bag, which happens quite often. Another name for this phenomenon is pseudoarthrosis.
The formation of a post-traumatic (acquired) false joint results in 2-3% of fractures. Most often, the tibia, radius and ulna bones suffer, and less often the humeral and femoral bones.A congenital pseudarthrosis can acquire a shin bone - this is 0.5% of all anomalies of the musculoskeletal system.
Complications arising from fractures of the jaws - a frequent phenomenon. Can occur:
- traumatic osteomyelitis;
- traumatic sinusitis (maxillary sinusitis);
- delayed consolidation of fragments;
- fusion of fragments in the wrong position;
- false joint.
The jaw function is completely impaired.
The false joint is divided into several groups.
Depending on the etiology:
The nature of the damage determines the false joints as:
According to the clinical x-ray picture, the joint can be of the following types:
- The emerging false joint, which is formed after the period of bone tissue accretion. It has painful sensations in the fracture zone, the feeling and movement of the sore joint is also painful. X-ray image reflects the crack. There is a periosteal callus.
- Also, the false joint may be tight (fibrous, slit-like).As a result, coarse fibrous tissue appears on the bone fragments, while the joint remains mobile (if there is no diastasis). A narrow slit is displayed on the x-ray.
- Necrotic pseudarthrosis. Gunshot wounds lead to this type, normal blood circulation is disturbed. It can also occur in fractures, when necrosis of the bones develops (most often the ankle bone, its body and neck, the femoral neck, the scaphoid bone in a transverse fracture).
- False joint of bone regenerate. This results in osteotomy of the tibia, namely, distraction (stretching) or fragile hardware fixation during lengthening of the segments.
- What else can be a false joint? A true false joint (non-arthrosis) most often affects single-boned segments with pathological mobility. Grinding of fragments occurs, and a fibrous cartilage with hyaline cartilage covers them from above. They form a space between them where the liquid is collected. As in the present joint, there is also a capsule, only the main substance in it is defective.
What else are pseudoarthrosis?
Depending on the degree of osteogenic activity, the joints may be of the following types:
- Hypertrophic false. In this case, the bone tissue grows at the ends of the fragments.It usually happens with an axial load on the limbs, when the mobility of fragments is low, and the vascular network of tissues that surround it is preserved.
- Avascular false joints with impaired blood circulation and poor bone formation, osteoporosis of bone fragments is possible.
This pathology is described by the International Classification of Diseases of the 10th revision. The ICD code "False joint" depending on the presence of purulent complications can be:
- Complicated purulent infection. This type of pathology is characterized by a fistula with pus, sequestration in the bones involved in the purulent process, as well as foreign bodies (this includes metal clamps, fragments of injuring projectiles).
What causes the disease
A false joint may develop due to the following factors:
- The presence of diseases in which the metabolism is disturbed in the body, as well as normal bone tissue regeneration (when the endocrine system is impaired, there is general intoxication, rickets, tumor cachexia).
- Consequences of the surgical intervention (chemical treatment provokes resection of fragments, they are loosely fixed).
- Postoperative treatment errors (the patient was not immobilized enough after osteosynthesis was performed, the load on the limb was too early, the bone fixation device was removed early).
- Mistakes of medical treatment (the plaster cast was changed too often, the immobilization was not complete with the help of gypsum, the fragments were shifted under the dressing, the fragments were overgrown with skeletal traction).
- The presence of suppuration.
Why else is a false joint? You can see photos of the consequences of such a disease in the article.
In addition, the pathology of the joints may develop for other reasons:
- Incorrect placement of bone fragments after the bones have been matched.
- The ingress of soft tissue in the gap between the bone fragments.
- Too much distance between the fragments.
- Insufficient blood circulation in the area of fragments.
- The presence of osteoporosis.
- Traumatizing the periosteum during surgery.
- Blockage of the medullary canal in bone fragments.
- The absence of a blood clot between fragments.
- Reaction to metal plates and nails during metalosteosynthesis.
- The presence of a foreign body between the fragments.
- Too many fragments.
- The use of certain medications. These include steroid hormones, anticoagulants.
- Concomitant tissue damage, burns, radiation.
Congenital pseudarthrosis occurs due to the fact that the nutrition and innervation of the corresponding limb segment inside the womb is disturbed. The affected area is filled with unformed tissue, as a result of the load on the limb, such bone tissue does not withstand.
Main symptoms and signs of the disease
The clinical symptoms of pseudoarthrosis are as follows:
- The appearance of increased mobility in unusual places on the human body. This increases the amplitude and direction of movement, which is atypical. This may not be too noticeable or, conversely, extraordinary. There are cases of limb rotation by 360 degrees in the area where the false joint is located. Photos of such defects show the seriousness of the disease.
- Shortening a limb that is damaged by 10 cm.
- Reduced muscle strength of the limb, since a false joint has formed on it.
- The functions of the legs or arms are impaired.This happens due to the absence of bone stops, as in a real joint. It cannot be fixed by muscles, ligaments or tendons. More often pseudo-articulations of the legs suffer from this.
- Tightening the limbs, the inability to move without support, you can not lean on a sore leg or arm. The patient uses crutches, a cane, a special orthopedic apparatus.
- Violation of the work of these joints, since the load on them has decreased.
Methods for diagnosing a false joint
The anamnesis and clinical symptoms, which we indicated above, make it possible to establish the diagnosis. But in some cases, there are no signs at all. This distinguishes fibrous hypertrophic joints, which have low mobility of fragments. This happens when a person has a false joint of the navicular bone, the fibula or the tibial.
The most accurate diagnostic method for the detection of pathology is x-ray examination. Pictures are made in two projections, perpendicular to each other. So all structural features of bones are better visible. Sometimes tomography is shown - also a very informative diagnostic method.
What are the distinctive signs of a false joint can be seen on the x-ray?
Callus is completely absent. And it should be between the ends of fragments. They are smooth and rounded, sometimes they have a conical shape. This is due to the fact that bone resorption has occurred, and there are no bone formation processes. It is characteristic of an atrophic false joint. Occurs overgrowth of the bone marrow cavity, the appearance of the endplate. This means that the restoration processes in the bone marrow have ceased. One of the fragments may have a hemispherical shape, which makes it similar to the head of the joint. The other fragment resembles the articular cavity, because it is concave in a certain way. There is a gap between the joints.
With the help of X-rays, you can identify a false joint, which has a slow fracture. Radioisotope research can determine the intensity of bone formation processes in the area of the false joint. The atrophic and hypertrophic forms of pseudoarthrosis will vary with this diagnostic method.
The continuity of the bone must be restored without fail. In addition, it is necessary to eliminate the deformation and normalize the work of the limb that has undergone damage.How are false joints and non-joint fractures treated? The doctor on the basis of existing symptoms develops a plan. In the treatment of pseudoarthrosis distinguish local and general activities. Common aims to strengthen the whole body. This helps to increase muscle tone, preservation and restoration of impaired functions of the injured limb, normalization of hemodynamics in the area of the false joint. It is necessary to regularly perform special therapeutic exercises, massage, physiotherapy.
Local activities create certain conditions for the regeneration to be normal. To this end, bone fragments come together and become immobilized, stimulation is sometimes performed, and blood circulation in the affected area is normalized. Must be carried out prevention and competent treatment of purulent complications.
These principles carry the three main methods of therapy. These include:
- Bone plasty.
- Steady osteosynthesis.
- Compression-distraction osteosynthesis.
The formation of a false joint affects the choice of therapy. The technique of skin plastics is rarely used compared to the others. It leads to the stimulation of osteogenesis in atrophic pseudarthrosis.It is imperative that suppurative complications be eliminated by prior excision of scars. Another condition is that a sufficient amount of time must pass from the moment the infection is eliminated (at least eight months).
Stable osteosynthesis is a process that is carried out with special fixatives. In this case, the bone fragments are in contact and fixedly fixed for close contact, but at the same time bone fragments are exposed, therefore this technique is also used in rare cases. So treat hypertrophic pseudarthrosis. There is a complete merging of the bone and the restoration of its integrity without bone grafting. But if the false joint of the atrophic form, then the latter can not be avoided.
When compression-distraction osteosynthesis produces a rapprochement and mutual compression of bone fragments. Deformation and shortening of the limb are eliminated. This is ensured by special devices, while the diseased arm or leg must be completely immobilized.
Therapy is selected depending on the shape of the false joint. That is, hypertrophic and atrophic pseudoarthrosis is treated differently.The method of therapy also depends on the localization of pseudoarthrosis:
- The false joint of the tibia or shoulder is treated by compression-distraction osteosynthesis using a closed method.
- Forearms with damage to the radial bone and the formation of clubhand need to be distracted with a special apparatus, then bone grafting is performed.
- Pseudarthrosis of the thigh is treated with intramedullary osteosynthesis, and if localized near the joint, then compression-distraction osteosynthesis is performed. The false joint of the lower jaw is also treated.
Which doctor to contact?
If there are signs of pseudoarthrosis, you need to make an appointment with a rheumatologist. This specialist conducts further treatment. Other physicians, such as a physiotherapist, massage therapist, surgeon, and arthroscopist, must also be involved in the complex therapy. They also treat the false joint of the jaws.
What is the prognosis of this disease? With the use of modern methods of treatment and also subject to timely treatment for medical care, the result will be positive. On average, the probability of this is 95% and even more. The way the patient himself relates to his condition greatly influences the outcome of the disease.It is unacceptable to neglect, delaying the visit to the doctor, self-treatment at home. The forecast will be disappointing if you do not listen to the recommendations of a specialist. The state of your health must be constantly monitored. If you have the slightest suspicion of a false joint, then you need to urgently visit a specialized medical institution.