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Pseudarthrosis: Causes, Symptoms & Treatment

Pseudarthrosis is a condition where a broken bone fails to heal properly, forming a false joint at the fracture site. Specialized treatment is often required.

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Things worth knowing about "Pseudarthrosis"

Pseudarthrosis is a condition where a broken bone fails to heal properly, forming a false joint at the fracture site. Specialized treatment is often required.

What is Pseudarthrosis?

Pseudarthrosis (also called a false joint or nonunion) is a condition in which a fractured bone fails to heal within the expected timeframe. Under normal circumstances, broken bones heal within weeks to months. If healing does not occur after approximately six months, the condition is medically classified as pseudarthrosis. Instead of forming solid bone tissue, the fracture site develops a mobile, joint-like structure – hence the term false joint.

Causes

Several factors can contribute to the development of pseudarthrosis:

Insufficient immobilization of the fractured bone following the injury
Poor blood supply to the fracture site, which impairs bone regeneration
Infection (septic pseudarthrosis), for example after open fractures or surgical procedures
Severe soft tissue damage to muscles, tendons, or surrounding tissues
Systemic conditions such as diabetes mellitus, osteoporosis, or thyroid disorders
Nutritional deficiencies, particularly calcium and vitamin D deficiency
Smoking, which has been shown to significantly slow bone healing
Medications such as corticosteroids or nonsteroidal anti-inflammatory drugs (NSAIDs)

Types of Pseudarthrosis

Hypertrophic Pseudarthrosis

Hypertrophic pseudarthrosis occurs when the bone retains its biological healing capacity but lacks mechanical stability. Excess callus tissue (bone repair tissue) forms at the fracture site. This type responds well to surgical stabilization procedures.

Atrophic Pseudarthrosis

Atrophic pseudarthrosis is characterized by severely impaired blood supply to the fracture site, which leads to a loss of regenerative capacity. This form is more difficult to treat and often requires additional biological stimulation, such as bone grafting.

Infected (Septic) Pseudarthrosis

Septic pseudarthrosis arises from infection at the fracture site. It is the most challenging form to treat and requires antibiotic therapy and often surgical debridement before bone healing can be pursued.

Symptoms

Common symptoms of pseudarthrosis include:

Persistent pain at the former fracture site, even after the cast or fixation has been removed
Abnormal mobility at a location that should have healed
Swelling and possible redness in the affected area
Functional limitations of the affected limb or joint
A sensation of instability during weight-bearing or movement

Diagnosis

Pseudarthrosis is typically confirmed through imaging techniques:

X-ray: The first line of investigation; shows absent bony bridging or excessive callus formation
Computed Tomography (CT): Provides detailed visualization of bone structure and healing progress
Magnetic Resonance Imaging (MRI): Assesses soft tissue involvement and blood supply
Laboratory tests: Used to rule out infections or metabolic disorders as underlying causes

Treatment

Conservative Treatment

In early or mild cases, non-surgical treatment may be attempted:

Ultrasound therapy (Low Intensity Pulsed Ultrasound, LIPUS): Stimulates bone regeneration
Extracorporeal Shock Wave Therapy (ESWT): Promotes bone metabolism and blood circulation
Electrical stimulation: Low-level electrical currents can positively influence bone healing
Risk factor management: Smoking cessation, treatment of underlying conditions, and nutritional optimization

Surgical Treatment

In most cases, surgical intervention is necessary:

Osteosynthesis: Stable fixation of the bone ends using screws, nails, or plates
Bone grafting: Transplantation of autologous (the patient's own) or allograft bone to provide biological stimulation
Bone Morphogenetic Proteins (BMPs): Application of growth-stimulating proteins to promote new bone formation
Infection management in septic cases before definitive reconstruction is attempted

Prognosis

The outlook for pseudarthrosis depends on the underlying cause, the bone affected, the general health status of the patient, and the timing of treatment. With modern surgical techniques, stable bone healing can be achieved in the majority of cases. Early diagnosis and timely intervention significantly improve the prognosis.

References

Ruter, A., Trentz, O., Wagner, M. (Eds.) - Unfallchirurgie. Urban & Fischer Verlag, 2nd edition (2008).
Zura, R. et al. - Epidemiology of Fracture Nonunion in 18 Human Bones. JAMA Surgery, 2016; 151(11): e162775. Available via PubMed.
Deutsche Gesellschaft für Unfallchirurgie (DGU) - Guidelines on Fracture Treatment and Pseudarthrosis Management. Available at: www.dgu-online.de

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