Congenital pseudarthrosis of the tibia: Results of circular external fixation treatment with intramedullary rodding and periosteal grafting technique.

OBJECTIVE: This study investigated the clinical and functional results of treating congenital pseudarthrosis of the tibia (CPT) using the combined techniques of hamartoma resection, periosteal grafting, circular external fixator application, and intramedullary rodding. METHODS: The clinical and radiological data of 17 patients (mean age at the treatment time: 7.6 months (range: 4.6-9.7 months) with CPT, treated by a single surgeon between 1997 and 2017, were retrospectively analyzed. All data regarding surgical interventions, complications, deformity analysis parameters, limb length discrepancy (LLD), ankle joint range of motion, and residual deformities were reviewed. All the patients were followed up at least two years after the last surgical intervention. The mean follow-up time was 8.5 years (range: 2.2 to 15.7 years). RESULTS: Union was achieved with the index treatment in 15 of the 17 cases (88.2%). The mean age of the patients at the last follow-up visit was 14.2 years (range: 7.6 to 22.1). The mean LLD was 2.1 cm. Nine patients had radiological ankle valgus at the last follow-up. In the entire series, eight patients did not display any complications, four cases reported minor complications, and five cases were complicated by refractures. CONCLUSION: Circular external fixator application combined with periosteal grafting is a superior method of CPT treatment. This method provides a healthy biological healing environment while correcting the mechanical problems. The combination of periosteal and cancellous bone grafts with intramedullary rods and an external fixator addresses issues that complicate obtaining and maintaining a union during the CPT treatment. LEVEL OF EVIDENCE: Level IV, Therapeutic study.

Síndrome de Caffey-Silverman / Caffey-Silverman syndrome

La enfermedad de Caffey o síndrome Caffey-Silverman es una enfermedad poco común, con una incidencia en torno a 48/100.000 recién nacidos vivos, caracterizada por un crecimiento anómalo y deformidad de huesos largos, siendo los más afectados, la mandíbula, parrilla costal y cúbito. En su forma más común, el desarrollo de la patología se produce a partir del segundo mes de vida. Su cuadro clínico característico consiste en un aumento y tumefacción de partes blandas, fiebre, hiperirritabilidad y dolor. Los estudios de imagen revelan un crecimiento subperióstico masivo, que habitualmente se resuelve de forma espontánea en torno a los dos años de vida, sin dejar habitualmente ninguna secuela objetivable. Existen otras formas más agresivas, aunque son menos comunes. El tratamiento en la forma autolimitada es sintomático (antipiréticos, analgésicos) y su manejo es conservador. Presentamos el caso de una lactante, en seguimiento en nuestro centro, con diagnóstico de enfermedad de Caffey (AU)

Caffey disease, or Caffey-Silverman syndrome, is a very uncommon illness with an incidence of 48/100,000 live newborns. It is characterised by an anomalous formation and deformity of long bones and typically also involves the mandible, ribs and ulnar bone. In the most common form, onset usually occurs around the age of 2 months. Frequent symptoms are fever, painful swelling of soft tissues, fever, irritability and general pain. Imaging studies show massive subperiosteal new bone formation that spontaneously resolves by the age of 2 years, normally with no apparent sequels. There are other severe forms of this disease but their incidence is much lower. Treatment of the most common form of Caffey disease is symptomatic (antipyretics and anti-inflammatory drugs). We report a case of Caffey disease in an infant who is under follow-up in our hospital (AU)

Pseudoartrosis humeral en fractura obstétrica tras osteomielitis aguda hematógena / Humeral pseudoarthrosis in obstetric fracture after acute hematogenic osteomyelitis

Introducción: La infección neonatal es una causa importante de morbimortalidad en la primera semana de vida a consecuencia de la exposición a microorganismos genitales maternos durante el parto. La sepsis neonatal se presenta como enfermedad fulminante y multisistémica, destacando la infección por klebsiella pneumoniae, con una mortalidad aproximada del 60%. Su asociación con un cuadro de osteomielitis aguda hematógena (OAH) es de difícil diagnóstico, con posibles complicaciones severas. Este cuadro de OAH asociado a fractura obstétrica precisa de intervención quirúrgica, tanto por su entidad infecciosa como por su posible evolución a pseudoartrosis. Caso clínico: Recién nacido a término con pérdida de bienestar fetal e ingreso en UCI por sepsis neonatal, con absceso en brazo izquierdo que drena espontáneamente y toma de cultivo positiva para klebsiella pneumoniae. Se comienza tratamiento antibiótico con cefotaxima y vancomicina sin mejoría tras 20 días, decidiéndose tratamiento quirúrgico con limpieza y estabilización mediante fijador externo con evolución favorable de su cuadro sistémico. A nivel de la fractura obstétrica se apreció falta de unión ósea con evolución a pseudoartrosis atrófica, por lo que se decidió reintervención con aporte de injerto óseo autólogo de cresta ilíaca y nueva fijación externa, con unión completa del foco a los dos meses y resolución del caso. Conclusión: La fractura obstétrica asociada a OAH es un cuadro poco frecuente que debe ser diagnosticado y tratado quirúrgicamente, con posibles complicaciones como la pseudoartrosis del foco fracturario (AU)

Introduction: Neonatal infection is an important morbimortality cause that occurs in the first week of life and it is a consequence to maternal genital microorganisms during partus. Neonatal sepsis is a sudden and multisystemic disease, standing out the infection by klebsiella pneumoniae, with an approximate mortality of 60%. Its association with acute hematogenic osteomyelitis has a difficult diagnose with severe income complications. Acute hematogenic osteomyelitis associated with an obstetric fracture needs surgical treatment because of its infectious importance and its possible evolution to pseudoarthrosis. Case report: Newborn with a loss of fetal wellness and entrance to intensivity care unit because of neonatal sepsis, with an abscess in his left arm that drains spontaneously and a positive biopsy to klebsiella pneumoniae. Antibiotic treatment with cefotaxime and vancomycin is started without any improvement after 20 days. Surgical treatment is decided with a cleaning procedure and stabilisation with external fixator, with a proper evolution of his sistemic clinic. Related to the obstetric fracture, non-union is appreciated with an evolution to atrophic pseudoarthrosis. A new surgical intervention is decided with the contribution of autologous bone graft from iliac crest and a new external fixator, with a complete bone union in two months and the clinical case solution. Conclusion: Obstetric fracture associated to acute hematogenic osteomyelitis is a low frequency episode that must be diagnosed and surgically treated with external fixation and autologous bone graft, with possible complications as pseudoarthrosis (AU)

Free vascularized fibular transfer with langenskiöld procedure for the treatment of congenital pseudarthrosis of the forearm.

Congenital pseudarthrosis of the radius or ulna is a rare entity. It is associated with neurofibromatosis, but occurs much less commonly than congenital pseudarthrosis of the tibia. Pseudarthrosis of the forearm can lead to pain, deformity, and limited forearm rotation. Nonsurgical management leads to poor results, as do surgical treatments such as open reduction internal fixation and conventional bone grafting. The transfer of a free vascularized fibula to the forearm pseudarthrosis has been more successful, and it is our preferred method of treatment for children with this condition. Because the transfer is often performed in young children, there is the potential for valgus deformity at the ankle after the fibula is removed. We describe here our technique for the transfer, including the technique for distal tibiofibular fusion (Langenskiöld procedure) after removal of the fibular graft. In addition, we present the results of 5 patients who have undergone this combination of procedures for pseudarthrosis of the forearm at our institution.

Implantes biodegradables en el tratamiento de pseudoartrosis de escafoides / Biodegradable implants in the management of scaphoid pseudoarthrosis

Objetivo: Presentamos los resultados del tratamiento quirúrgico de la ausencia de consolidación del escafoides mediante reducción abierta, injerto óseo y fijación interna biodegradable. Material y métodos: Estudio prospectivo de 16 pacientes con pseudoartrosis de escafoides tratados quirúrgicamente mediante reducción abierta, injerto óseo y fijación interna con tornillos biodegradables de ácido poli-Lláctico reforzado entre los años 2002 a 2006. Se valoran la movilidad, escala visual analógica (EVA) del dolor, cuestionario DASH, complicaciones, resultado radiológico y laboral a los 37 meses de seguimiento prospectivo medio (rango, 12-104 meses). Resultados: El 90% de los pacientes volvio a su mismo puesto de trabajo y nivel de actividad a las 16 semanas (rango, 9-24 semanas). Al final del seguimiento, el arco de movilidad medio fue 103,3º de flexoextensión y 47º de desviación lateral, EVA 1.6 y DASH 4.6, sin diferencias estadísticamente significativas entre ambos grupos. Conclusión: El curetaje con aporte de injerto procedente de la cresta iliaca es una buena alternativa para el tratamiento de la pseudoartrosis de escafoides. Los implantes biodegradables hacen innecesario retirar el material, facilitan la cirugía de revisión y permiten realizar estudios con resonancia magnética para evaluar la viabilidad ósea. Los resultados del presente estudio ofrecen una alternativa válida de fijación en la pseudoartrosis de escafoides (AU)

Objetive: Results of the surgical management of the lack of scaphoid consolidation via open reduction, bone grafting and biodegradable internal fixation. Material and methods: 16 patients with scaphoid pseudoarthrosis subjected to surgery with open reduction, bone grafting and internal fixation using biodegradable reinforced polylactic acid screws between the years 2002- 2006. Antebrachial plaster immobilization was carried out for 8 weeks after surgery. Evaluations were made of mobility and pain (visual analog scale, VAS), DASH questionnaire, complications, and radiological and occupational results after an average of 37 months of prospective follow-up (range 12-104 months). Results: Most patients (90%) were able to return to the same work and level of activity, after an average of 16 weeks (range 9-24). At the end of follow-up, the mean mobility range was 103.3 degrees in flexion-extension and 47 degrees in lateral deviation, with a VAS score of 1.6 and a DASH score of 4.6. There were no statistically significant differences between the two treatment groups. Conclusion: Curettage with bone grafting from the iliac crest is a good alternative for the management of scaphoid pseudoarthrosis. Biodegradable implants eliminate the need to remove the material, facilitate revision surgery, and allow magnetic resonance imaging studies to assess bone viability. The results of the present study offer a valid fixation alternative in patients with scaphoid pseudoarthrosis (AU)

A modified Matti-Russe technique for the treatment of scaphoid waist non-union and pseudarthrosis.

BACKGROUND: The aim of this study was to analyze the long-term results of a modified Matti-Russe technique for the treatment of scaphoid non-union and pseudarthrosis. The modification was based on the use of bone graft taken from the ipsilateral distal radius, rather than from the iliac crest, as originally described. MATERIAL/METHODS: Between 1987 and 2000, 23 consequent male patients with scaphoid waist non-union or pseudarthrosis underwent surgery by a modified Matti-Russe technique. During the 5-year follow-up, patient evaluation was based on radiological findings and the Green and O'Brien scoring system. RESULTS: Anatomy was restored and healing of the non-union was achieved in 21 (91.3%) patients. The other 2 patients failed to achieve union and underwent the same operation a second time, which was successful. According to the Green and O'Brien scoring system, 82.6% (19/23) of patients showed excellent results and 17.4% (4/23) showed good results at 2-year follow-up. At 5-year follow-up, 73.9% of patients (19/23) had excellent results and 26.0% (4/23) had good results. No early post-operative complications developed. Two patients demonstrated mild radiological radio-scaphoid arthritis at 2.5 years postoperatively. All patients returned to previous levels of activity. CONCLUSIONS: The standard Matti-Russe technique is an old but reliable and inexpensive method for the treatment of long-standing or neglected scaphoid non-unions or pseudarthroses. The modification of this established method, based on use of the distal radius as a donor site, reduces operative time, can be performed through a single approach, does not show donor site morbidity, and allows the use of regional anaesthesia.

Elite male adolescent gymnast who achieved union of a persistent bilateral pars defect.

An adolescent 15-yr-old male competitive gymnast presented to a university-based multidisciplinary spine institute with a persistent low-back pain for 18 mos. Although the results of x-rays were negative, his pain rendered him unable to compete in his sport any longer. A computed tomography scan was performed, which showed a bilateral pars fracture at L5, without spondylolisthesis. A nuclear medicine bone scan revealed negative findings, confirming chronic nonunion. The patient completed a 4-wk course of physical therapy 6 mos before our intervention, without any relief of pain or radiologic evidence of healing. The patient was treated with a bone stimulator for 4 hrs/day and was recommended to wear a warm-and-form-type brace. Isometric core trunk exercises were also initiated. Only after 6 wks of treatment, the subject showed clinical improvement at the follow-up visit. Computed tomography scan performed 12 wks after the initial scan showed complete union of the fracture correlating with clinical improvement. Two years later, the athlete remains completely pain-free, is training regularly, and is able to compete on a national and, possibly, international level.

[The strategy of rehabilitative treatment following surgical intervention in patients with pseudoarthrosis of the extremities].

The objective of the present study was to analyse results of the treatment of 267 patients with pseudoarthrosis of the extremities and to use them for the development of criteria for the choice of methods for rehabilitative therapy. It was shown that stability of fixation of bone fragments by metal devices in patients with false joints (unlike fractures) varies depending on bone tissue condition. With this in mind, the patients receiving rehabilitative treatment were allocated to three groups differing in the degree of immobilization in the postoperative period. One group included the patients who did not need immobilization of the affected extremity. The other comprised those requiring immobilization only in case of axial load. Patients of the third group needed immobilization throughout the entire period until the completion of fragment consolidation. The results thus obtained were used to develop tactical schemes of combined treatment of patients using up-to-date orthotic techniques. It is proposed to divide the postsurgery treatment schedule into the following periods: early postoperative, early rehabilitative, the onset of active functional loading, and the period of functional and vocational rehabilitation. Such a differentiation is believed to enhance efficiency of the above rehabilitative strategy and facilitate the adequate choice of combined remedial treatments. Excellent and good outcome of rehabilitation with the use of this technology have been achieved in 98.9% of the patents.

[Pseudoarthrosis of the first rib in a patient who practices yoga. A case report]. / Seudoartrosis de la primera costilla en una practicante de yoga. Presentación de un caso.

INTRODUCTION: Pseudoarthrosis of the first rib is a rare condition that may occur in athletes as a result of repetitive activities, mainly overhead. The usual clinical presentation is pain in the neck or the ipsilateral shoulder. CASE REPORT: This is the case of a 19-year-old female patient who had sudden pain of the base of the neck while doing yoga. Pseudoarthrosis of the first rib was diagnosed with X-rays and CAT scan. Treatment consisted of a rehabilitation and physical therapy program that was successful despite the persistence of the pseudoarthrosis. DISCUSSION: Cases of first rib fractures have been reported in athletes practicing multiple activities; however, pseudoarthrosis cases are rare since most of them progress to bone healing. This is the first reported case of a fracture or pseudoarthrosis in a patient practicing yoga. As in most reported cases, conservative treatment was successful. CONCLUSION: Fractures and pseudoarthrosis of the first rib are rare in athletes and should be included in the differential diagnosis of athletes presenting with shoulder and neck pain. Conservative treatment is successful in most cases.

Lesión arterial en fracturas abiertas de huesos largos / Arterial lesion in open fractures of long bones

Se hace un estudio prospectivo de 2532 pacientes atendidos en el servicio de Ortopedia y Traumatología del Hospital Territorial Docente de Cárdenas en el período de tiempo comprendido entre enero del 1984 y Enero del 2004, por presentar fracturas de huesos tubulares largos asociado a daño arterial, correspondiente al grupo IIIC propuesto por Gustilo y Andersen . Predominaron los pacientes del sexo Masculino (73.1por ciento), Raza Blanca (60.1por ciento)y grupos de edades comprendidos entre 41 y 50 años (38por ciento). Los traumas por alta energía (48.3por ciento) fueron la causa etiológica de la lesión más frecuente. El medio estabilización de la fractura más utilizado fue la fijación externa(95.1por ciento). Un 78.6por ciento del total de la muestra presentó compresión, desgarro o sección de la pared vascular. Solo en el 7.5por ciento de los casos hubo ligadura del vaso por considerarque la circulación colateral seria incapaz de manteneruna oxigenación tisular adecuada. La evolución finalfue favorable en el 76.4por ciento de la totalidad de la muestra.Los resultados considerados malos se debieron variaciones en el proceso de consolidación del tejido óseo. La proporción de producción de la matriz y su degradación dependen directamente de la población celular. La isquemia e hipoxia subsiguiente originan una hipofunción celular que tardará en recuperarse proporcionalmente al tiempo de no-vascularización. Este será, junto a factores osmolares y ácido básicos las causas que afecten el fenómeno de osificación

An outcomes analysis of the treatment of cervical pseudarthrosis with posterior fusion.

STUDY DESIGN: A retrospective review of 33 consecutive patients treated with posterior fusion and selective nerve root decompression for the treatment of pseudarthrosis following anterior cervical discectomy and fusion. OBJECTIVES: Use standardized outcome measures to evaluate the results of posterior fusion with selective nerve root decompression as a treatment option for symptomatic pseudarthrosis of the cervical spine. SUMMARY OF BACKGROUND DATA: Pseudarthrosis after anterior cervical discectomy and fusion has been recognized as a cause of continued cervical pain and unsatisfactory outcomes. Debate continues as to whether a revision anterior approach or a posterior fusion procedure is the best treatment for symptomatic cervical pseudarthrosis. To our knowledge, standardized outcome measures have not been used to evaluate the results of either surgical treatment option; therefore, it is difficult to evaluate outcomes in these patients, let alone compare surgical treatment options. Data on fusion rates in these two surgical treatment groups suggest a trend of a higher fusion rate with utilization of a posterior revision procedure, but the largest study to date includes the study of only 19 patients treated with a posterior fusion. METHODS: Thirty-three consecutive patients with symptomatic pseudarthrosis following anterior cervical discectomy and fusion were treated with selective nerve root decompression and posterior fusion using iliac crest or local bone graft as well as posterior wiring and/or lateral mass plating. The average follow-up period was 46 months (range, 20-86 months). Patients were assessed using physical examination, flexion-extension lateral radiographs, and standardized outcome measures including the SF-36, Arthritis Impact Measurement Scales 2, and Cervical Spine Outcomes Questionnaire. RESULTS: All 33 patients (100%) demonstrated a solid fusion at their most recent follow-up, and all 33 patients noted significant improvement in their preoperative symptoms. No difference in fusion status was noted between those treated with iliac crest versus patients treated with local bone graft--all had a solid fusion; 72% of the patients were satisfied with the result of their surgery. Cervical Spine Outcomes Questionnaire pain scales demonstrated 52% of patients reported mild or nopain at follow-up, whereas 20% described their pain as "discomforting" and 28% of the patients continued to report moderate to severe pain. CONCLUSIONS: This is the first study to our knowledge to use standardized outcome measures to assess clinical outcome in patients treated with posterior fusion for pseudarthrosis after anterior cervical discectomy and fusion. Patients and surgeons need to understand the potential for success with this revision procedure but also be aware of the relatively high rate of continued moderate to severe pain observed in this patient population even after a solid fusion is achieved. All of the patients in this study fused with a single posterior fusion procedure, further supporting the relatively higher fusion rates observed in the literature using posterior fusion as a treatment for cervical pseudarthrosis. Our results also support the ability of surgeons to use local bone graft without iliac crest in a posterior fusion for cervical pseudarthrosis and therefore avoid the morbidity associated with iliac crest bone graft harvest.

Treatment of infected defect pseudoarthrosis of the tibia by in situ fibular transfer in children.

The aim of this study was to determine the effectiveness of in situ fibular transfer in the treatment of infected defect pseudoarthrosis in childhood. Four cases with infected defect pseudoarthrosis of the tibia were treated with debridement, sequestrectomy and two-staged ipsilateral fibular transfer. The mean age of the patients was 7.5 (2-11) years. Mean follow-up period was 9.5 (6-13) years. In all cases infection was resolved and tibia-fibular synostosis was achieved. The diameter of the transferred fibula increased significantly with regard to the unaffected fibula. None of the patients had limitation of joint motion or shortening more than 1cm. This technique is a good method for treatment of infected defect pseudoarthrosis of the tibia.

Electromagnetismo: aplicaciones clínicas en aparato musculoesquelético / Electromagnetism: clinical applications in musculoskeletal apparatus

Introducción: La acción de los campos electromagnéticos, sobre los organismos vivos, está en investigación desde hace décadas. En nuestro trabajo hemos pretendido reunir la información existente en la literatura científica sobre la eficacia del electromagnetismo en sus diferentes indicaciones en el aparato locomotor para poder identificar las que probablemente sean más efectivas y realizar un mejor uso en la práctica clínica diaria. Búsqueda bibliográfica: La búsqueda se realizó a través de Medline, Pubmed y The Cochrane Library, restringida al período de 1985-2001, sin límites en el idioma. Se revisaron 68 artículos que fueron evaluados mediante la clasificación de los niveles de calidad de la evidencia científica, según la propuesta de la Agencia de Evaluación de la Tecnología Médica del Servicio Catalán de la Salud. Resultados: Se observa una importante eficacia sobre los retrasos de consolidación, pseudartrosis, fracturas de reciente producción y osteotomías, en trabajos con una evidencia científica alta. Encontramos una probable eficacia de los campos electromagnéticos sobre la prevención de la osteoporosis y la mejora del dolor en la artritis, en trabajos con un nivel de evidencia media. En el resto de las patologías no se encuentran un número suficiente de ensayos de buena calidad para realizar conclusiones fiables (AU)

Results of Sauve-kapandji procedure.

INTRODUCTION: Sauve-Kapandji procedure is used to treat distal radioulnar joint disorder. MATERIALS AND METHOD: Sixteen patients with distal radioulnar joint (DRUJ) disease treated with Sauve-Kapandji procedure between 1996 and 1998 were available for review at an average follow up period of 32.8 months,ranging from 24 to 48 months. The patients were young and the average age at the time of procedure was 33.6 years. There were eight cases of post-traumatic DRUJ arthritis, two cases of dislocation of DRUJ with malunion of radial fractures and six cases of rheumatoid patients with destruction of DRUJ. The distal end of ulnar shaft was stabilised with a sling created using radial 1/2 slip of extensor carpi ulnaris (ECU) tendon. Functional results were evaluated with Mayo wrist score. RESULTS: Fusion of DRUJ was achieved in all cases by two months. Excellent results were achieved in eight cases, good in six, fair in one and poor in one. All except one case gained increase range of forearm rotation. Complications included one case of closure of pseudoarthrosis and required excision of the ulna head to restore forearm rotation. CONCLUSION: Sauve-Kapandji procedure is recommended in young patients with distal radioulnar joint disorder.

The efficacy of anterior cervical plating in the management of symptomatic pseudoarthrosis of the cervical spine.

STUDY DESIGN: A retrospective review of 16 consecutive patients treated with anterior resection of the pseudoarthrosis, autogenous iliac crest bone grafting, and stabilization with an anterior cervical plate. OBJECTIVES: To determine the efficacy of anterior cervical plating used to manage symptomatic pseudoarthrosis of the cervical spine and obtain safe radiographic fusion and improved clinical results. SUMMARY OF BACKGROUND DATA: It is generally recognized that the clinical outcome of anterior cervical discectomy and fusion correlates with rates of fusion. There is debate in the literature as to how the patient with symptomatic cervical pseudoarthrosis should be addressed. Recent reports would support a posterior approach rather than a revision anterior approach. METHODS: Sixteen consecutive patients with symptomatic pseudoarthrosis of the cervical spine were treated with anterior resection of the pseudoarthrosis, autogenous iliac crest bone grafting, and stabilization with an anterior cervical plate. The average follow-up period was 51 months, and patients were assessed using physical examinations, questionnaires, and flexion-extension lateral radiographs. RESULTS: In all, 75% of the patients reported improvement of their symptoms, and 69% of patients returned to work. Fusions were graded I or II in 81% of the patients. No patient demonstrated radiographic instability, and none required revision surgery. Involvement with workers' compensation litigation negatively affected the clinical outcome. CONCLUSIONS: Patients in whom symptomatic cervical pseudoarthrosis develops after cervical anterior discectomy and fusion may be managed successfully with anterior resection of the pseudoarthrosis, autogenous bone grafting, and an anterior cervical plate. Successful clinical results regarding return to work status and general satisfaction with the surgical procedure depend not only on obtaining a successful radiographic fusion, but also on patient selection.

[Treatment principles in aseptic pseudarthrosis]. / Behandlungsprinzipien bei aseptischen Pseudarthrosen.

Aseptic pseudarthrosis may occur after all kinds of traumatology treatment. Following conservative treatment, incomplete immobilisation or an unattached bone fragment can be causal. After plate osteosynthesis the biomechanical principles are not efficient or the circulatory damage delays healing. There are two broad types of pseudarthrosis: vascular and nonvascular. The extent of vascularisation can be demonstrated by bone scintigraphy as well as X-ray. The treatment of vascular nonunions is very common. Mechanical stability is required, therefore a new osteosynthesis is desirable. Osteoporosis caused by inactivity and dislocation increases the rate of complications. Much more difficult problems are encountered in treatment of unreactive and avital pseudarthrosis, particularly in cases with a defect of bone substance. These defects can be treated with a segment transfer and a fibula-to-tibia operation. Extracorporal lithotripsy has been established as a new method in treatment of active and vascular nonunions. Former osteosynthesis is not a contraindication. Stability and immobilisation are necessary. Treatment in the low-frequency magnetic field shows no effect. Correct biomechanical and biological osteosynthesis with proper attention paid to location, quality of bone and asepsis can avoid the development of a pseudarthrosis.

[Corrective osteotomy of the femoral and tibial shafts using the interlocking nail]. / Korrekturosteotomien an Femur- und Tibiaschaft mit dem Verriegelungsnagel.

The indication for nailing a femur or tibia fracture has been extended by the method of interlocking up to the meta/diaphyseal zone. For the stabilisation of osteotomies in these regions, the nail was used in 19 cases of femur and 23 of tibia corrections between 1983 and 1988 in the Orthopedic University Clinic Berlin. The osteotomies were done with a small skin incision in open way. Although there were three infections, bone consolidation was succeeded in all but one patient with the planned axis. The first achieved gain in length could not be hold in five cases after removing the interlocking screws in order to give full weight bearing to the leg for callus formation. In situations of non-unions with wrong position or refracture of biologically troubled bones after plating the method of interlocking nail is stable and enables bone recovery after grafting by drilling. The possibility of early full weight bearing is a great advantage for the rehabilitation of patients, who had been suffering from delayed fracture healing before. The nail itself preserves the right position of the bone in two dimensions, even if there are not exact fitting osteotomy fragments, and the interlocking screws secure the shorter part of diaphysis against malrotation.