Treatment of Pseudoarthrosis and Osteomyelitis

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Service Manager

Prof. Attilio Santucci

Surgeon

Specialist in Orthopedics and Traumatology

TEAM MEMBERS

Dr. Pier Francesco Mariani

Surgeon

Specialist in Orthopedics and Traumatology

PSEUDARTHROSIS

Pseudarthrosis is the failure of a bone fracture to heal approximately 6 months after the event (from 3 to 6 months it is referred to as delayed union). It is a late complication caused by the interruption of the physiological healing processes of the fracture.

Depending on the shape that the two bone stumps take at the end, at the fracture line, we distinguish two types of pseudarthrosis:

  • Atrophic:
    the tips of the two bone segments are thinned to the point of completely avoiding contact;
  • Hypertrophic:
    the end of the bone segments widens like an elephant's foot where the two stumps touch but are not fused together.
CAUSE
  • Lack of fusion:
    there is a failure to form bone callus, the bone is unable to produce the necessary bone tissue to fuse the fragments.
  • Development of a "false joint":
    due to the absence of fusion, the area affected by the fracture becomes mobile and unstable, behaving like an artificial joint.

The diagnosis is made through a specialist visit supported by radiological investigations (X-rays, CT, MRI) in assessing the degree of bone non-union.

  • Stability issues:
    excessive movement of bone fragments prevents the correct formation of bone callus.
  • Inadequate conservative or surgical treatment
  • Insufficient vascularization:
    the fracture site has a reduced vascular supply resulting in a lack of oxygen, cells, and growth factors.
  • Infections
  • Patient-specific factors negatively affecting microvascular circulation:
    advanced age, smoking (nicotine), anemia, corticosteroid therapies, diabetes, nutritional deficiencies, unbalanced diet.
  • Conservative treatment (non-surgical):
    • Pulsed Electromagnetic Fields (PEMF): Stimulate the bone’s biological activity and the healing of nonunited bone tissue.
    • Shockwaves: Generate a cavitation process that attracts growth factors and stimulates regeneration of blood vessels and bone tissue.
    • Magnetotherapy: Promotes blood flow and calcification at the fracture area.
    • Physiotherapy rehabilitation, drug therapy, vitamin supplementation: Strengthen the tissues surrounding the fracture area and support functional recovery.
  • Surgical treatment:
    • Osteosynthesis: internal or external fixation devices are applied to stabilize the fracture.
    • Bone grafts: autologous or homologous grafts are used to fill bone gaps and promote reactivation of healing.
    • Innovative techniques: Regenerative medicine with growth factors or treatments such as distraction of the pseudoarthrosis site.

OSTEOMYELITIS

Osteomyelitis is a bone infection caused by pathogens (the most common is Staphylococcus aureus and, more rarely, fungi or clostridia).
Children and the elderly are more frequently affected, but it can develop in anyone.
Depending on the location and onset, it can be:

  • Acute osteomyelitis, resulting from the direct attack of a pathogen or from hematogenous spread from adjacent infected soft tissues.
  • Vertebral osteomyelitis, with gradual development, causes persistent back pain that worsens with movement and is not relieved by rest.
  • Chronic osteomyelitis, resulting from osteomyelitis treated without resolution of the infection. Sometimes, it is not detectable for a long time and does not produce symptoms for extended periods. It causes bone pain, recurrent infections in the soft tissues over the bone with pus secretion.
CAUSES
  • Hematogenous:
    transfer of the pathogen through the bloodstream.
  • Direct invasion by the pathogen:
    through open fractures, postoperative wounds, or synthesis means that perforate the bone.
  • Secondary to contiguous infection
  • Associated with peripheral vascular problems
The risk of developing the disease increases in the case of:
  • Smoking
  • Chronic diseases with circulation disorders (diabetes, peripheral arterial disease, kidney failure, sickle cell anemia..)
  • Recent injury or orthopedic surgery
  • Diseases requiring intravenous drug administration or catheter application
  • Weakened immune system
  • Injections of substances using non-sterile devices or non-disinfected skin

The Cierny-Mader classification provides a guideline for the treatment of osteomyelitis, in relation to the severity and extent of the pathology:

  • Type I Osteomyelitis (medullary canal):
    targeted antibiotic therapy is initiated, then, if necessary, surgical intervention with thorough cleaning is performed.
  • Type II Osteomyelitis (cortical bone):
    surgical removal of the infection through debridement and the use of flaps or advanced closure techniques to fill spaces in the treated tissue.
  • Type III and IV osteomyelitis:
    require surgical treatments with extensive bone resections and, in the most severe cases, external fixators. Prosthetic implants may be needed to fill bone loss; bone grafts or bone substitutes (PMMA, polymethylmethacrylate) are used, in combination with techniques such as the Masquelet technique, or distraction osteogenesis with external fixation. In extreme cases, amputation may be necessary.

For information and bookings

Monday / Friday 8:00 AM – 8:00 PM / Saturday 8:00 AM – 7:30 PM

06 35528500

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