Cases reported "Pseudarthrosis"

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1/6. A case of congenital pseudarthrosis of the tibia treated with pulsing electromagnetic fields. 17-year follow-up.

    Congenital pseudarthrosis of the tibia presents surgeons with one of the most challenging of all orthopedic problems. Various surgical treatments have succeeded only rarely. We report long-term follow-up of a patient with congenital pseudarthrosis of the tibia treated with pulsed electromagnetic fields (PEMF) and bone grafting. In this severe case, Bassett type III and Boyd type II, encouraging results were achieved with Boyd's dual onlay grafts and PEMF. Seven years after surgery, skeletal maturity was complete and an unacceptable degree of leg shortening had been avoided.
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2/6. Congenital pseudarthrosis of the tibia: treatment with local steroid infiltration.

    A new treatment was used for 3 cases of congenital pseudarthrosis of the tibia based on the method used for the treatment of simple bone cysts by local infiltration of steroids. All 3 cases achieved consolidation and had no recurrence. This method may be used in association with the numerous other methods used in the treatment of congenital pseudarthrosis of the tibia (bone transplants, vascularized transplants using microsurgical techniques, electromagnetic induction, and the use of external fixators). It is particularly useful for cases treated at a very early age (even at a few months) when other types of treatment could be difficult to carry out and usually fail.
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3/6. The development and application of pulsed electromagnetic fields (PEMFs) for ununited fractures and arthrodeses.

    This article deals with the rational and practical use of surgically noninvasive pulsed electromagnetic fields (PEMFs) in treating ununited fractures, failed arthrodeses, and congenital pseudarthroses (infantile nonunions). The method is highly effective (more than 90 per cent success) in adult patients when used in conjunction with good management techniques that are founded on biomechanical principles. When union fails to occur with PEMFs alone after approximately four months, their proper use in conjunction with fresh bone grafts insures a maximum failure rate of 1 to 1.5 per cent. Union occurs because the weak electric currents induced in tissues by the time-varying fields effect calcification of the fibrocartilage in the fracture gap, thereby setting the stage for the final phases of fracture healing by endochondral ossification. The efficacy, safety, and simplicity of the method has prompted its use by the majority of orthopedic surgeons in this country. In patients with delayed union three to four months postfracture, PEMFs appear to be more successful and healing, generally, is more rapid than in patients managed by other conservative methods. For more challenging problems such as actively infected nonunions, multiple surgical failures, long-standing (for example, more than two years postfracture) atrophic lesions, failed knee arthrodeses after removal of infected prostheses, and congenital pseudarthroses, success can be expected in a large majority of patients in whom PEMFs are used. Finally, as laboratory studies have expanded knowledge of the mechanisms of PEMF action, it is clear that different pulses affect different biologic processes in different ways. Selection of the proper pulse for a given pathologic entity has begun to be governed by rational processes similar, in certain respects, to those applied to pharmacologic agents.
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4/6. Treatment of delayed union and pseudarthrosis by low frequency pulsing electromagnetic stimulation. Study of 35 cases.

    This is a study of 35 cases of delayed union or established fibrous union ("pseudarthrosis") treated by pulsing electromagnetic stimulation. The treatment, applied up to 12 hours per day, can be carried out at home, with clinical and radiological control every 60 days. The average time of healing was 6 months. Consolidation occurred in 88.5% of cases, usually without the production of excessive periosteal callus. The method was particularly useful and effective in infected fractures, failed bone grafts, revascularisation of fragments showing signs of necrosis, and fractures with associated skin lesions.
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5/6. Treatment of pseudarthroses with electrodynamic potentials of low frequency range.

    In 319 patients suffering from septic and noninfected pseudarthroses, bone consolidation has been achieved in 93.6% by a cancellous bone graft plus a semi-invasive method of electrostimulation of nonunion using low frequency A.C. potentials, i.e., the electrodynamic procedure. By inductively coupled electromagnetic fields, the potentials are produced in inductable implants. There are no contraindications for the procedure and no side effects.
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keywords = electromagnetic
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6/6. Treatment of an adult with neglected congenital pseudoarthrosis of the tibia with acute fracture: a case report.

    Treatment of congenital pseudoarthrosis of the tibia is very difficult. Numerous surgical procedures have been used including bone grafting, fixation, pulsed electromagnetic field, vascularized fibular bone grafting and lengthening devices. Previous studies, often reporting unsatisfactory results, are limited to children and adolescents. In adults, the following factors need to be considered: leg length discrepancy, leg deformity, soft tissue problems, lack of potential for growth and difficulties in healing. We reported a case of untreated congenital pseudoarthrosis of the tibia with fracture in a 32-year-old man. Conventional treatments used included excision of the pseudoarthrosis, correction of the deformity, intramedullary fixation, bone grafting and soft tissue transplantation for lengthening and coverage. These procedures led to good bony union and a satisfactory outcome.
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