Healing of bones after a fracture occurs due to the formation of a "bone callus" - a loose, shapeless tissue that connects parts of a broken bone and contributes to the restoration of its integrity. But fusion does not always go well. It happens that the fragments do not heal in any way, the edges of the bones, touching, eventually begin to grind, grind and smooth out, leading to the formation of a false joint (pseudoarthrosis). In some cases, a layer of cartilage may appear on the surface of the fragments and a small amount of joint fluid may appear. In medical practice, the most common are the thighs and lower legs.

Features of the pathology

Pseudarthrosis is usually acquired or, in rare cases, congenital. It is assumed that such a congenital ailment is formed as a result of a violation of bone formation in the prenatal period. Usually, pseudoarthrosis is localized in the lower part of the leg, and this pathology is detected at the time when the child begins to take his first steps. There is also a congenital false joint of the clavicle. This malformation is very rare. However, it can also be acquired, which is very difficult to treat.

An acquired false joint occurs after a fracture, when the bones do not grow together correctly. Quite often this happens after gunshot or open injuries. Sometimes its appearance is associated with some surgical interventions on the bones.

Reasons for the formation of pseudarthrosis

The development of pathology is associated with a violation of the normal process of bone tissue healing after a fracture. The common causes of the disease are diseases in which there is a violation of the bones and metabolism:

• rickets;
• multiple injuries;
• pregnancy;
• endocrinopathy;
• intoxication;
• tumor cachexia.

Bone fragments usually do not heal as a result of local causes:

• impaired blood supply to fragments;
• damage to the periosteum during the operation;
• reaction of the organism to metal osteosynthesis, rejection of nails and plates;
• bone fracture with numerous fragments;
• taking steroid hormones, anticoagulants;
• after the operation, the fragments were poorly compared relative to each other;
• the occurrence of a large distance between the parts of the bones as a result of strong traction;
• an infectious lesion that led to the formation of suppuration in the area of ​​​​the fracture;
• osteoporosis;
• the immobility of the limb did not last long;
• damage to the skin associated with a fracture - radiation, burns.

Changes that occur in the limb due to the formation of such a pathology as a false joint, in half of all cases contribute to persistent and severe disability of a person.

Formation of pseudoarthrosis

When a false joint begins to form, the gap formed by bone fragments is filled with connective tissue, and the bone plate closes the canal. This is the main difference between a false joint and a slow bone fusion.

As the disease begins to progress, mobility in such a “joint” increases. Typical articular surfaces are formed at the ends of bone fragments that articulate with each other. They also form articular cartilage. The altered fibrous tissues surrounding the "joint" form a "capsule" in which synovial fluid arises.

Symptoms of pathology

The symptoms of a false joint are quite specific, and the doctor is able to make a preliminary diagnosis only on their basis, after which it is confirmed by an x-ray.

• Pathological mobility in a place in the bone where it should not normally occur. In addition, the amplitude and direction of movements in the true joint may increase, which is impossible in a healthy person. This condition provokes a false joint of the femoral neck.
• Mobility in the pathological area may be barely noticeable, but sometimes occurs in all planes. In medical practice, there have been cases when the limb at the site of the false joint turned 360 degrees.
• Shortening of the limb. It can reach ten centimeters or more.
• Atrophy of leg muscles.
• Severe impairment of limb function. To move, the patient uses crutches and other orthopedic devices.
• When resting on the leg, pain appears in the area of ​​pseudarthrosis.

But there are cases when the symptoms of the pathology are insignificant or may even be absent during the formation of a false joint on one of the bones of the two-bone segment. This happens if one of the two bones that form the lower leg or forearm is affected.

A fracture is a very dangerous injury, especially if it occurs in the elderly. Women are more likely to undergo such a fracture, which is associated with the occurrence of osteoporosis during menopause. Osteoporosis contributes to a decrease in bone density, and it develops due to hormonal changes during menopause.

Diagnostics

X-ray method is used to confirm the diagnosis. A false joint on radiographs appears in two versions:

• Hypertrophic pseudarthrosis is a very rapid and excessive growth of bone tissue in the area of ​​​​a fracture with a normal blood supply. On x-ray, you can see a significant increase in the distance between the ends of the bone fragments.
• Atrophic - the occurrence of a false joint occurs with insufficient blood supply or its absence. On the radiograph, you can clearly see the clear boundaries of the edges of the fragments held by the connective tissue, but it is not too strong to immobilize the site of the pathological formation.

Treatment

If a false joint has formed, it is treated only with the help of surgical intervention. In hypertrophic pseudoarthrosis, fragments are immobilized using metal osteosynthesis in combination with tissue. After that, within a few weeks, complete mineralization of the cartilage layer occurs and the bone begins to grow together. With atrophic pseudarthrosis, areas of bone fragments are removed, in which the blood supply is disturbed. Then parts of the bones are connected to each other, completely eliminating their mobility.

After the operation, massage, exercise therapy, and physiotherapy are prescribed to restore muscle tone, mobility of nearby joints and improve blood supply.

Output

Thus, we examined what a false joint is, the symptoms of this disease and its treatment were also considered. If a fracture occurs, it is necessary to follow all the recommendations of the doctor and not move the injured limb for as long as possible so that the bones grow together correctly. Otherwise, pseudarthrosis can cause severe complications.

Normally, after a fracture, the fragments are fused. First, connective tissue is formed at the fracture site, then callus, which undergoes a number of changes. Sometimes, due to various reasons, consolidation of the fracture does not occur.

With an increase in the timing of the union of the fracture, they speak of sluggish consolidation. After 6 months or more, or when the average period of fracture consolidation is exceeded by 2 or more times, they speak of the formation of a false joint (pseudoarthrosis).

A false joint after a fracture is characterized by the formation of end plates on bone fragments parallel to the fracture line. The medullary canal is closed with such plates. The role of the joint space is performed by the fracture line. Such a joint has neither a capsule nor ligaments, it is not functional.

Contribute to the formation of a false joint, general and local factors. Common reasons:

• pregnancy;
• rickets;
• endocrine disorders (diabetes mellitus, hypoparathyroidism, Addison's disease);
• violation of electrolyte metabolism (calcium, phosphorus);
• elderly age;
• damage to the nervous system;
• cancer intoxication.

Non-union of fragments can occur for reasons:

• incorrect comparison (reposition) of bone fragments;
• premature removal of the plaster splint, its incorrect imposition;
• fragile fixation of fragments during osteosynthesis;
• getting muscles, soft tissues, foreign body between bone fragments (interposition);
• large distance (defect) between fragments;
• insufficient blood supply in the fracture area (for this reason, pseudarthrosis often occurs with fractures of the scaphoid, talus, femoral neck);
• bone osteomyelitis.

Classification

False joints can be congenital and acquired. Congenital are formed as a result of intrauterine violation of the formation of bone tissue. Such pseudoarthroses appear when the child starts to get up and walk.

Acquired ones are formed with prolonged nonunion of the fracture. There are hypo- and hypertrophic variants of pseudarthrosis. Hypotrophic develops against the background of osteoporosis in violation of the blood supply to the bone tissue. There is a gradual resorption of fragments.

In the hypertrophic variant, a false joint is formed against the background of excessive callus formation. More often this happens with a large divergence of fragments.

Clinic

1. The appearance of pathological mobility where it should not be.
2. Shortening of the limb by 10.0 cm or more.
3. Appearance of visible deformation.
4. Dysfunction of the injured limb. This is especially noticeable in the example of the lower extremities. Their support function is disturbed, gait changes. When walking, it becomes necessary to use a cane, crutches, or other devices that perform the function of a support.
5. The appearance of pain and discomfort in the area of ​​the false joint with axial load, for example, when resting on the leg.
6. Atrophy of muscle tissue, muscle hypotension due to a decrease in the motor activity of the injured limb.

Diagnostics

The presence of a false joint can be suspected by clinical signs. The final diagnosis is based on radiographs. They show the closure of the medullary cavity at the ends of the fragments, the formation of end plates. There is also smoothness, rounding of bone fragments, the appearance of the joint space of pseudarthrosis. Sometimes, when the x-ray picture is in doubt, an MRI or CT scan is performed.

Treatment

Treatment is possible only by surgery. Carry out the restoration of the integrity of the bone tissue. Bone fragments are compared, the end plates are cleaned, osteosynthesis is carried out using a metal structure or the Ilizarov apparatus.

In some cases, bone grafting is performed. In this case, a bone plate taken from another area, most often from the iliac wing (Femister's technique), is placed in place of the bone tissue defect.

There is also a technique according to Khakhutovperformed by a sliding graft. A bone graft is sawn out, consisting of 2 parts (1st picture). Then the large inert plate is shifted so that it covers the fracture site (3rd cut). The short plate is shifted to the vacated area.

When a fracture occurs in the femoral neck in old age, it often does not grow together with the subsequent formation of a false joint. This is because the femoral neck is poorly supplied with blood. The best result in such cases is the operation.

False joint or pseudarthrosis- This is a pathology that is characterized by a violation of the continuity of the bone and the development of mobility in an unusual department for it.

False joints can be acquired or congenital.

Congenital false joints are caused by intrauterine pathologies of the formation of the bone system, and acquired false joints are, in most cases, a complication after bone fractures, fragments of which were fused with disorders.

Acquired false joints are divided into:

Hypertrophic

atrophic

Normotrophic

Causes of a false joint (pseudoarthrosis).

Factors that largely influence the formation of a false joint are usually a strong divergence of bone fragments relative to their previous state after their fusion, insufficient immobility or premature termination of immobilization, early loading on a fragile limb, the development of a purulent process in the fracture zone, impaired blood circulation in the fragment zone . Sometimes a false joint can form after orthopedic operations, such as osteotomy, as well as with various irregular fractures.

The gap formed by bone fragments that formed a false joint is filled with connective tissue instead of callus. The longer a false joint exists in a person, the stronger the mobility of this joint develops, a new joint (neoarthrosis) can develop, which has a capsule, an articular cavity with synovial fluid, and the articulating ends of the bone covered with cartilage.

Symptoms and signs of a false joint (pseudoarthrosis).

The false joint is characterized by pathological mobility in a section unusual for this, usually in the area of ​​the diaphysis. Mobility can be weak, and can reach movements with a fairly strong amplitude. In some cases, symptoms may be mild or absent altogether. In the case of a false joint on the lower limb, a person experiences pain when walking.

The severity of congenital false joints is stronger than acquired ones. Pathology is especially noticeable in children who begin to walk if false joints are located on the lower extremities in the shin area.

Diagnosis of a false joint (pseudoarthrosis).

When making a diagnosis, in addition to clinical data, they are also guided by the period that is necessary for the union of a particular fracture. After this period, the status of the fracture is determined as slowly fused or not fused, and after a period that is 2 times higher than the norm, they speak of the formation of a false joint.

An X-ray for the diagnosis of a fracture is carried out in two projections, mutually perpendicular, and sometimes an X-ray is performed in oblique projections. The main signs of the presence of a false joint on the radiograph are:

Absence of callus, which is a connector of bone fragments

Conical or rounded, smoothed shape of the ends of bone fragments (false atrophic joint)

Development of the end plate (infection of the cavity at both ends of bone fragments).

With a false joint in one fragment, the end may have a hemispherical shape, and in appearance resembles an articular head, while in the other it may be concave like a glenoid cavity. The joint gap in this case is clearly visible on radiographic images.
To determine the intensity of the process of bone formation in the false joint, a radionuclide study is used.

Treatment of a false joint (pseudoarthrosis).

For the treatment of a false joint, mainly surgical methods are used, for example, osteosynthesis in combination with bone grafting.

7643 1

False joint after fracture - tubular bone disorder with the appearance of mobility in parts unusual for it.

A false joint appears after 3% of fractures, often occurs after a fracture of the femoral neck, radius, congenital - on the lower leg.

Making up 0.5% of all congenital lesions of the motor system.

Classification of pathology

By origin, they distinguish:

• acquired;
• congenital.

• fibrous without loss of bone substance;
• true;
• lesions with bone loss.

Formation method:

• normotrophic;
• atrophic;
• hypertrophic.

What can cause the phenomenon

Common reasons:

• congenital abnormalities in the development of bones;
• cancerous tumors;
• endocrine problems;
• malnutrition;
• intoxication;
• rickets;
• pregnancy.

local reasons:

An ununited fracture and a false joint are also often adjacent to each other.

What indicates pathology

The clinical picture of the disorder is always visually expressed.

The most common place for the appearance of this deviation is concentrated in the ankle area, so the curvature that occurs during the development of a false joint is striking.

If a load is given to the sore leg, then it will tuck in at the site of the lesion, because. the muscles of this leg are extremely weak.

Main signs:

• pain at the site of injury for the entire period of treatment;
• deformation at the site of injury;
• unhealthy mobility;
• violation of support and gait;
• decrease in muscle tone of the limb;
• mobility in the joints above and below the injury is limited;
• swelling of parts of the limb below the fracture;
• X-ray shows a clear fracture line, displacement.

Establishing diagnosis

The diagnosis is made by a traumatologist on the basis of anamnesis, clinical picture, time elapsed since the injury. If the average time required for the union of the fracture has passed, then this indicates a slow recovery.

In the case when the fusion period is exceeded several times, a false joint is diagnosed.

Such a division in medicine is conditional, but it is of great importance when choosing a treatment algorithm. With delayed fusion, there is a chance for fusion. If a false joint occurs, self-recovery is impossible.

Basic way diagnostics - x-ray.

On x-rays, hypertrophic and atrophic pseudarthrosis are determined:

1. Hypertrophic pseudoarthrosis is characterized by active growth of bone tissue at the site of injury. On x-ray - expansion of the ends of the fragments.
2. At atrophic lesion borders of the ends of fracture bones are visible. The central part of it may not have a border if a rough scar has formed, but the edges of the fracture line are clearly visible.

Healing procedures

There are conservative methods (administration of drugs, electrical stimulation, etc.), but the main treatment is surgery - compression osteosynthesis.

Principles of surgical treatment:

• carried out after 6-12 months. after wound healing;
• scars should be removed and skin plasty should be performed, this does not apply to extrafocal osteosynthesis;
• fragments must be compared;
• refreshing the ends of bones, repairing canals and removing scars.
• the most used interventions:
• intervention on the principle of "Russian castle";
• osteosynthesis with grafts;
• Chaklin operation.

When defeated, use devices Ilizarov, Kalnberz etc.

When combining a high-quality connection of fragments, retention by means of devices and bone plasty, the results of treatment are significantly improved.

In case of damage to the tibia, osteosynthesis makes it possible to achieve fusion without surgery, to neutralize inflammation. The period of stay of the limb in the apparatus and fusion is up to 8 months. You can load the limb after 2 months. after the procedure.

Serious difficulties are observed in the treatment of bone loss disorders that appear due to open fractures, radical surgical treatment of a bone wound, when large areas of bone are removed. In this situation, a large bone defect is visible on the x-ray.

The treatment then is often surgical. If it is not necessary, orthoses should be worn.

With “dangling” joints, plastic surgery and bypass plastic surgery of the bone are used, with damage to the tibia, the Gan-Huntington operation.

One of the conditions for fusion is the strength of the connection of fragments.

Neglect of this rule is the reason for the recurrence of the disease, and requires a new operation.

Is it possible to prevent deviation?

Prevention of congenital false joint does not exist.

And the prevention of acquired defects is adequate treatment of fractures, high-quality immobilization of the diseased organ.

People often ask to remove the cast earlier because nothing hurts, they have to go somewhere or work. You can’t do this, because. if the plaster is removed earlier, a false joint will appear at the site of the injury.

In order to prevent the development of this deviation, the consequence of which is disability, and the treatment may require several operations, one should adhere to all medical prescriptions, and after removing the plaster, use an elastic bandage.

A “bone callus” is formed, which is a shapeless and loose mass, due to which bone tissue is restored between the fragments. For a more accurate fusion of bones, various methods are used: the imposition of gypsum, traction of the bones of the skeleton, the connection of fragments with metal plates, knitting needles, etc. However, under the influence of various factors, in some cases, the tubular bone does not grow together. After some time, its adjoining and rubbing edges are smoothed out and form a false joint (or pseudoarthrosis) - one of the complications in the treatment of fractures. Sometimes a thin layer of cartilage and fluid forms on the edges of the bones of such an formation, and a capsule similar to a joint bag appears around.

The first attempts to treat such complications of fractures were made by Hippocrates. They were not successful, because only conservative methods were used for these purposes - tapping the damaged area with a wooden hammer and administering drugs to activate the growth of callus. Later, surgical operations began to be performed to eliminate false joints (according to Beck, Yazykov, Khakhutova, and others).

According to some statistics, such a complication in the treatment of closed fractures is observed in 5-11% of cases, and open - in 8-35%. Pseudarthrosis often occurs after damage to the radius and femoral neck, and in congenital pathology - on the lower leg (on the border of the lower and middle thirds of the tibia). In this article, we will introduce you to the causes, varieties, main symptoms and methods of treating pseudarthrosis.

Causes

The reason for the formation of a false joint may be incorrect immobilization of the limb after a fracture and displacement of bone fragments.

The appearance of a congenital false joint is provoked by intrauterine pathologies. They are more often unilateral and appear on the tibia. The frequency of their development is on average 1 case per 190 thousand children. The appearance can be caused by the following intrauterine pathologies:

• amniotic constriction;
• fibrous dysplasia;
• underdevelopment of blood vessels in their embryonic defect;

The development of acquired false joints can be caused by such internal or external causes:

• improper treatment of fractures - displacement of bone fragments under plaster, incorrect immobilization of the limb with a plaster bandage, frequent replacement of plaster, overstretching during skeletal traction, insufficient immobilization of the limb after osteosynthesis, early and excessive loads on the broken limb, premature removal of the apparatus for fixing fragments;
• consequences of surgical interventions - resection of fragments, fragile fixation;
• diseases leading to disruption of normal bone regeneration and metabolism (for example, endocrine pathologies, tumor cachexia, general intoxication);
• purulent complications.

The following cases can cause the appearance of acquired pseudoarthrosis:

• penetration of soft tissues or foreign bodies into the gap between the ends of a broken bone;
• excessive amount of fragments;
• incorrect matching of the ends of a broken bone;
• insufficient blood circulation in the area of ​​fragments;
• a large distance between the ends of a broken bone;
• absence of a hematoma between the ends of a broken bone;
• trauma to the periosteum during surgical procedures;
• reaction during metal osteosynthesis to metal devices (plates, bolts, nails);
• blockage and closure of the bone marrow canal in fragments with a plate;
• additional tissue damage (burns, radiation);
• taking or steroids.

Varieties of false joints

Depending on the cause of pseudarthrosis, there are:

• congenital;
• acquired: pathological and traumatic.

Depending on the nature of the damage, pseudarthrosis can be:

• non-firearms;
• firearms.

Depending on the clinical manifestations detected during x-rays, false joints are of the following types:

1. Forming. Appears during the completion of the period necessary for normal bone fusion. On the x-ray, clear boundaries of the “gap” of the fracture and bone callus are determined. The patient feels pain in the damaged area and when trying to palpate it.
2. Fibrous. Fibrous tissue is revealed between the ends of the bone and a narrow "gap" is visible on the picture. Joint mobility is severely limited.
3. Necrotic. Appears after gunshot wounds or fractures that have a predisposition to the development of bone necrosis. Such pseudoarthrosis is more often observed with injuries of the neck of the talus and femur or the median part of the navicular bone.
4. Pseudarthrosis of bone regenerate. Appears with an incorrect osteotomy of the tibia with its excessive stretching or insufficiently strong fixation to the apparatus for lengthening the segments.
5. True (or neoarthrosis). In most cases, it develops on single-bone segments with their excessive mobility. With such pseudoarthrosis, fibrous cartilage tissue with areas of hyaline cartilage appears on the edges of the fragments. A formation similar to a periarticular bag appears around the debris, which contains fluid.

Depending on the method of formation and intensity of bone formation, pseudarthrosis are:

• hypertrophic - growths of bone tissue appear at the ends of a broken bone;
• normotrophic - there are no bone growths on the fragments;
• atrophic (or avascular) - in such joints, blood circulation is disturbed, bone formation is poor or often accompanied by osteoporosis of a broken bone.

According to its course, pseudoarthrosis can be:

• uncomplicated - not accompanied by infection and the appearance of pus;
• infected - the addition of a purulent infection leads to the formation of fistulas and sequesters (cavities) localized in the bone, from which pus is released, fragments of shells or metal clamps may be present in such joints.

Symptoms

With a false joint, the following main symptoms are observed:

• atypical subtle or extremely pronounced mobility of those parts of the body in which movements do not normally occur;
• an uncharacteristic increase in the direction or amplitude of movements;
• reduction in the length of the arm or leg up to 10 cm;
• swelling below the fracture site;
• decrease in muscle strength of the limb with pseudoarthrosis;
• violation of the functions of a broken limb;
• changes in the functions of nearby joints.

Diagnostics

In addition to examining and analyzing the patient's complaints, an X-ray examination is performed to diagnose pseudarthrosis. For a more detailed examination of the structural changes in the bones, x-rays should be performed in two perpendicular projections. In a number of difficult cases, the patient is assigned tomography.

When studying x-rays with pseudarthrosis, the following changes are revealed:

• the callus connecting the fragments is absent;
• fragments of a broken bone become rounded and smoothed (sometimes they become conical due to the lack of bone formation in atrophic pseudarthrosis);
• at the ends of fragments of the cavity, the bones overgrow and endplates appear on them, stopping regeneration in the tissues of the bone marrow;
• a gap is revealed between the "articular surfaces" in both projections;
• sometimes one of the fragments has the shape of a hemisphere, resembling an articular head, and the other has a concave surface and looks like an articular cavity.

X-rays can reveal a false joint. To determine the intensity of bone formation and clarify the form of pseudoarthrosis - hypertrophic or atrophic - a radioisotope study is carried out.

Treatment

The main method of elimination of false joints is a surgical operation. Conservative therapy aimed at eliminating pseudoarthrosis and consisting in the use of drugs for the fusion of fragments and in physiotherapy does not give the expected effect.

The main goal of treatment is to restore the continuity of the broken bone. After that, measures are taken to eliminate the deformities that cause a violation of the affected limb. The treatment plan is drawn up depending on the clinical case and the individual characteristics of the patient.

To eliminate the false joint, general and local measures are used.

General therapeutic measures

Patients with false joints are recommended measures aimed at increasing muscle tone, stabilizing blood circulation in pseudoarthrosis, maintaining and restoring the functions of the affected leg or arm. For this, patients are prescribed physiotherapeutic procedures, massage and a set of exercises for physiotherapy exercises.

Local treatment

Local treatment of pseudoarthrosis involves an operation, the purpose of which is to create favorable conditions for the proper fusion of fragments. To do this, their ends are brought together and immobilized. During the intervention, the surgeon pays attention not only to the approach of fragments, but also creates conditions for adequate blood circulation in the fracture area. In addition, infection prevention or treatment of purulent complications is carried out.

Local treatment can be carried out according to the following methods:

• compression-distraction osteosynthesis;
• stable osteosynthesis;
• bone grafting.

Tactics of local treatment is selected depending on the type of false joint. With its hypertrophic form, the operation can be extrafocal - a compression-distraction apparatus is applied to the limb. And in case of atrophic pseudarthrosis, to restore the integrity of a broken bone, it is first necessary to carry out its plastic surgery.

When choosing a surgical technique, the location of pseudoarthrosis is also taken into account:

• with periarticular localization, compression-distraction osteosynthesis is performed;
• in case of localization on the upper or middle third of the thigh, intramedullary osteosynthesis is performed;
• with localization on the radius (with the development of clubhand) - first, hardware distraction is performed, and then - bone grafting;
• in case of localization on the humerus or tibia, compression-distraction osteosynthesis is performed.

Compression-distraction osteosynthesis

This method of treatment is performed with the help of special devices that provide comparison of fragments. In this case, the broken arm or leg must be completely motionless. The device allows for maximum approximation and mutual compression of the ends of the broken bone. In addition, this method makes it possible to eliminate shortening or deformities of the limbs. To ensure immobilization, the apparatuses of Kalnberz, Ilizarov, etc. are used. The essence of the method is to remove bone sections that form a false joint, bring them closer together and press them against each other. After the formation of the callus, the fragments begin to gradually move away from each other, restoring the length of the limb and the integrity of the bone.

Sustainable osteosynthesis

To perform this method of treatment, special fixators (plates, rods) are used, which provide the contact and immobility of the damaged bone fragments necessary for fusion. For their imposition during surgery, the damaged areas of the bone are exposed. In hypertrophic pseudarthrosis, the union of the bone with the help of stable osteosynthesis occurs without performing a bone grafting operation, but in atrophic pseudoarthrosis this preliminary intervention should be carried out.

Bone grafting

This surgical method is used infrequently, but only in cases where it is necessary to stimulate osteogenesis in atrophic pseudarthrosis. Before carrying out such operations, it is necessary to eliminate purulent processes, perform excision of cicatricial changes and plastic surgery of the skin. From the moment of completion of the treatment of purulent complications to the date of the operation for bone grafting, at least 8-12 months should pass.

Rehabilitation and results

Regular physical therapy exercises help to recover from illness.

The duration of immobilization of the affected limb with false joints is 2-3 times longer than in the treatment of a conventional fracture of the same bone. After its completion, the patient is assigned a rehabilitation program.