[Treatment principles in aseptic pseudarthrosis]

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.