A pseudarthrosis occurs when a broken bone fails to heal, resulting in a false joint that is unstable and sometimes painful. Treatment options include electrical stimulation, grafting, and fixation. Risk factors for nonunion include poor blood supply, severe breaks, age, and medical history. Follow-up exams are important to identify early signs of delayed union or nonunion.
A pseudarthrosis is literally a “false joint,” in which a broken bone fails to heal and the ends of the broken bone become rounded from wear and tear and move against each other in a joint-like fashion. Unlike true joints, however, nonunions do not have joint fluid-filled capsules and do not develop musculature to support the joint. As a result they are very unstable and sometimes painful. Actual joints connected to a bone with nonunion will themselves be destabilized because the supporting bone is no longer intact.
When bones break, there is a risk that they will not heal properly. Some things may be recognizable risk factors, such as a poor blood supply bone, a severe break, the patient’s age, and the patient’s medical history. Sometimes this results in a delayed union, where the bone takes a long time to stitch back together. In other cases, there is a non-union; the ends of the bone do not join, and nonunion can develop.
A congenital pseudarthrosis can occur if someone suffers a fracture near birth and it results in a pseudarthrosis. The rapidly growing child’s bones will adjust to the pseudarthrosis and begin to round. Bones also typically bend due to lack of support. Nonunions in children can lead to gait abnormalities and other problems. Adults can also experience nonunions and sometimes develop nonunions after fusion surgery on the spine.
There are a variety of treatment approaches for a nonunion. Less invasive techniques, such as electrical stimulation of bones to promote new bone growth, will be tested first. If these are not effective, grafting can be used to encourage the bones to grow together. Fixation, in which orthopedic devices are fitted to the bone to hold it in place as it heals, may also be an option. Fixation can keep the ends of the bone stabilized long enough for new bone matrix to form so that the nonunion can heal.
When a fracture is diagnosed, the possibility of the development of nonunion may be considered. Cast immobilization is typically used to treat fractures, so the bones will have the opportunity to heal, and additional measures, such as fixation at the time of the fracture, may also be used. Follow-up exams will be used to check the course of healing and to identify early signs of a delayed union or nonunion.
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