ASEPTIC PSEUDOARTHROSIS - PRINCIPLES OF TREATMENT

Aseptic pseudarthrosis may occur after all kinds of traumatology treat ment. Following conservative treatment, incomplete immobilisation or a n unattached bone fragment can be causal. After plate osteosynthesis t he biomechanical principles are not efficient or the circulatory damag e delays healing. There are two broad types of pseudarthrosis: vascula r and nonvascular. The extent of vascularisation can be demonstrated b y bone scintigraphy as well as X-ray. The treatment of vascular nonuni ons is very common. Mechanical stability is required, therefore a new osteosynthesis is desirable. Osteoporosis caused by inactivity and dis location increases the rate of complications. Much more difficult prob lems are encountered in treatment of unreactive and avital pseudarthro sis, particularly in cases with a defect of bone substance. These defe cts can be treated with a segment transfer and a fibula-to-tibia opera tion. Extracorporal lithotripsy has been established as a new method i n treatment of active and vascular nonunions. Former osteosynthesis is not a contraindication. Stability and immobilisation are necessary. T reatment 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.