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Pseudoarthrosis

MedGen UID:
46175
Concept ID:
C0033785
Finding; Pathologic Function
Synonyms: Pseudarthroses; Pseudarthrosis; Pseudoarthroses
SNOMED CT: Fibrous nonunion (31511007); Nearthrosis - disorder (31511007); Pseudoarthrosis (410818009); Pseudarthrosis (410818009); Pseudoarthrosis (31511007); Nearthrosis (31511007); Neoarthrosis (31511007)
 
HPO: HP:0005864

Definition

A pathologic entity characterized by a developmental defect in a long bone leading to bending and pathologic fracture, with inability to form a normal bony callus with subsequent fibrous nonunion, leading to the pseudarthrosis (or "false joint"). [from HPO]

Conditions with this feature

Osteoglophonic dysplasia
MedGen UID:
96592
Concept ID:
C0432283
Congenital Abnormality
Osteoglophonic dysplasia (OGD) is characterized by multisuture craniosynostosis (including cloverleaf skull), distinctive craniofacial features (prominent forehead, proptosis, widely spaced eyes, low-set ears, midface retrusion, short nose, anteverted nares, prognathism, high palate, failure of tooth eruption, and gingival overgrowth), profound short stature with rhizomelia, and short, broad hands and feet. Radiographs show copper beaten appearance to skull, multiple cystic long bone lesions consistent with non-ossifying fibromas, irregular vertebral bodies, and osteopenia with increased risk of fractures.
Osteofibrous dysplasia
MedGen UID:
895748
Concept ID:
C4085248
Finding
Osteofibrous dysplasia (OSFD) is a tumor-like bone lesion that usually presents as a painless swelling or anterior bowing of the tibia (Park et al., 1993), although pain may occur in up to 25% of cases and presentation may follow pathologic fracture. Most reports of osteofibrous dysplasia describe isolated tibial lesions, although a significant subgroup describe isolated and ipsilateral fibular involvement. Cases with ulnar and radial involvement have been reported (summary by Hunter and Jarvis, 2002). OSFD is characterized by radiolucent lesions located at the periosteal surface of the diaphyseal cortex, almost exclusively of the tibia and fibula. These lesions are congenital and spontaneously resolve during skeletal maturation; the residuum is most commonly mild bowing at the affected site. Prior to their resolution, secondary complications such as nonunion fractures and pseudoarthrosis formation can occur. Histologically, OSFD lesions exhibit 'zonal architecture' characterized by spindle-shaped fibroblast-like cells in the center of the lesions that are progressively replaced with peripherally located, more differentiated cells from the osteoblastic lineage. The cells lying at the center of the lesions stain for markers of undifferentiated mesenchymal cell states, whereas bridging zones of osteoid with surface osteoblasts and embedded osteocytic cells are interspersed between the lesions. In OSFD, the unossified zones eventually mineralize after replacement with normal osteoid and, finally, bone. This histologic progression corresponds with the clinical and radiographic resolution of the lesions (summary by Gray et al., 2015). Hunter and Jarvis (2002) noted that there may be a relationship between osteofibrous dysplasia and adamantinoma of long bones (102660), although the latter condition usually presents at a later age.
Ophthalmoplegia, external, with rib and vertebral anomalies
MedGen UID:
1648445
Concept ID:
C4748418
Disease or Syndrome
External ophthalmoplegia with rib and vertebral anomalies (EORVA) is characterized by congenital nonprogressive external ophthalmoplegia and ptosis, with torticollis and scoliosis developing during childhood. In addition, patients exhibit hypoplastic or missing ribs with fusion anomalies (Di Gioia et al., 2018).
Osteogenesis imperfecta, IIA 22
MedGen UID:
1801631
Concept ID:
C5676943
Disease or Syndrome
Osteogenesis imperfecta comprises a group of connective tissue disorders characterized clinically by bone fragility, low bone mass, and increased susceptibility to fractures. Osteogenesis imperfecta type XXII (OI22) is a severe recessive form of the disease (Dubail et al., 2020).

Professional guidelines

PubMed

Kwok IHY, Ieong E, Aljalahma MA, Haldar A, Welck M
Foot (Edinb) 2022 May;51:101889. Epub 2021 Dec 10 doi: 10.1016/j.foot.2021.101889. PMID: 35255399
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Injury 2020 Nov;51(11):2414-2420. Epub 2020 Sep 16 doi: 10.1016/j.injury.2020.09.030. PMID: 32972722
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J Pediatr Orthop B 2011 Sep;20(5):323-9. doi: 10.1097/BPB.0b013e328347a361. PMID: 21691227

Recent clinical studies

Etiology

Zileli M
Acta Neurochir Suppl 2023;130:141-156. doi: 10.1007/978-3-030-12887-6_18. PMID: 37548734
Callanan G, Radcliff KE
Neurosurg Clin N Am 2021 Oct;32(4):461-472. Epub 2021 Jul 29 doi: 10.1016/j.nec.2021.05.007. PMID: 34538472
Gulcek M, Gamli M
J Orthop Surg (Hong Kong) 2018 May-Aug;26(3):2309499018803002. doi: 10.1177/2309499018803002. PMID: 30278806
Karikari IO, Metz LN
Neurosurg Clin N Am 2018 Jul;29(3):365-374. doi: 10.1016/j.nec.2018.03.005. PMID: 29933804
Truntzer J, Vopat B, Feldstein M, Matityahu A
Eur J Orthop Surg Traumatol 2015 Feb;25(2):211-5. Epub 2014 May 31 doi: 10.1007/s00590-014-1488-y. PMID: 24879610

Diagnosis

van de Minkelis J, Peene L, Cohen SP, Staats P, Al-Kaisy A, Van Boxem K, Kallewaard JW, Van Zundert J
Pain Pract 2024 Sep;24(7):919-936. Epub 2024 Apr 14 doi: 10.1111/papr.13379. PMID: 38616347
Ambatkar SY, Rudey MD
Pan Afr Med J 2023;44:112. Epub 2023 Mar 1 doi: 10.11604/pamj.2023.44.112.39077. PMID: 37275298Free PMC Article
Gill KG
Pediatr Radiol 2022 Apr;52(4):777-785. Epub 2021 Nov 3 doi: 10.1007/s00247-021-05200-x. PMID: 34731287
Forrester DM
Semin Ultrasound CT MR 2004 Dec;25(6):461-73. doi: 10.1053/j.sult.2004.09.003. PMID: 15663317
Gumà M, Olivé A, Pérez R, Holgado S, Ortiz-Santamaría V, Tena X
Clin Exp Rheumatol 2001 Nov-Dec;19(6):740-7. PMID: 11791652

Therapy

Gill KG
Pediatr Radiol 2022 Apr;52(4):777-785. Epub 2021 Nov 3 doi: 10.1007/s00247-021-05200-x. PMID: 34731287
Callanan G, Radcliff KE
Neurosurg Clin N Am 2021 Oct;32(4):461-472. Epub 2021 Jul 29 doi: 10.1016/j.nec.2021.05.007. PMID: 34538472
So E, Wilson MD, Chu AK, Prissel MA
J Foot Ankle Surg 2018 Jul-Aug;57(4):776-780. Epub 2018 May 11 doi: 10.1053/j.jfas.2018.01.002. PMID: 29759927
Tan LA, Riew KD, Traynelis VC
Neurosurgery 2017 Dec 1;81(6):893-898. doi: 10.1093/neuros/nyx477. PMID: 29096033
Gonugunta V, Krishnaney AA, Benzel EC
Neurol India 2005 Dec;53(4):424-32. doi: 10.4103/0028-3886.22608. PMID: 16565533

Prognosis

Hariharan AR, Shah SA, Petfield J, Baldwin M, Yaszay B, Newton PO, Lenke LG, Lonner BS, Miyanji F, Sponseller PD, Samdani AF; Harms Study Group
Spine Deform 2022 Sep;10(5):1097-1105. Epub 2022 Apr 30 doi: 10.1007/s43390-022-00508-6. PMID: 35488969
So E, Wilson MD, Chu AK, Prissel MA
J Foot Ankle Surg 2018 Jul-Aug;57(4):776-780. Epub 2018 May 11 doi: 10.1053/j.jfas.2018.01.002. PMID: 29759927
Chaverri D, Vives J
Biomark Med 2017 Dec;11(12):1125-1133. Epub 2017 Nov 28 doi: 10.2217/bmm-2017-0180. PMID: 29182015
Westberry DE, Davids JR, Pugh LI
J Pediatr Orthop 2014 Jan;34(1):86-91. doi: 10.1097/BPO.0b013e3182a007a0. PMID: 23872807
Forrester DM
Semin Ultrasound CT MR 2004 Dec;25(6):461-73. doi: 10.1053/j.sult.2004.09.003. PMID: 15663317

Clinical prediction guides

Basso MA, Smeraglia F, Ocampos-Hernandez M, Balato G, Bernasconi A, Corella-Montoya F
Acta Biomed 2023 Oct 17;94(5):e2023194. doi: 10.23750/abm.v94i5.14646. PMID: 37850769Free PMC Article
Chaverri D, Vives J
Biomark Med 2017 Dec;11(12):1125-1133. Epub 2017 Nov 28 doi: 10.2217/bmm-2017-0180. PMID: 29182015
Truntzer J, Vopat B, Feldstein M, Matityahu A
Eur J Orthop Surg Traumatol 2015 Feb;25(2):211-5. Epub 2014 May 31 doi: 10.1007/s00590-014-1488-y. PMID: 24879610
Iacobellis C, Baldan S, Aldegheri R
Musculoskelet Surg 2011 Dec;95(3):199-203. Epub 2011 Apr 9 doi: 10.1007/s12306-011-0129-4. PMID: 21479728
Gonugunta V, Krishnaney AA, Benzel EC
Neurol India 2005 Dec;53(4):424-32. doi: 10.4103/0028-3886.22608. PMID: 16565533

Recent systematic reviews

Basso MA, Smeraglia F, Ocampos-Hernandez M, Balato G, Bernasconi A, Corella-Montoya F
Acta Biomed 2023 Oct 17;94(5):e2023194. doi: 10.23750/abm.v94i5.14646. PMID: 37850769Free PMC Article
Assouto C, Bertoncelli CM, Gauci MO, Monticone M, Bagui S, Rampal V, Solla F
Int Orthop 2022 Nov;46(11):2577-2583. Epub 2022 Jun 15 doi: 10.1007/s00264-022-05470-6. PMID: 35701591
Kesireddy N, Kheireldin RK, Lu A, Cooper J, Liu J, Ebraheim NA
J Pediatr Orthop B 2018 Nov;27(6):541-550. doi: 10.1097/BPB.0000000000000524. PMID: 29878977
Killington K, Mafi R, Mafi P, Khan WS
Curr Stem Cell Res Ther 2018;13(4):284-291. doi: 10.2174/1574888X12666170915121137. PMID: 28914208
Morelli I, Drago L, George DA, Romanò D, Romanò CL
J Pediatr Orthop B 2018 Sep;27(5):443-455. doi: 10.1097/BPB.0000000000000456. PMID: 28368930

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