Pseudoarthrosis
Cheryl A. Petersilge, MD
DIFFERENTIAL DIAGNOSIS
Common
Fracture, Nonunion
Failed Graft
Rare but Important
Neurofibromatosis (NF)
Congenital Pseudoarthrosis
Osteogenesis Imperfecta (OI)
Fibrous Dysplasia
Ankylosing Spondylitis, Post-Trauma
ESSENTIAL INFORMATION
Helpful Clues for Common Diagnoses
Postoperative (Nonunion & Failed Graft)
Hint: Motion, especially in spine
Hint: Look for hardware failure
Tibia common due to poor blood supply
Radiographic findings
Nonbridging callus, may be hypertrophic
Smooth sclerotic margins
Helpful Clues for Rare Diagnoses
Neurofibromatosis (NF)
Tibia, clavicle, radius, ulna
Congenital pseudoarthrosis similar
a.k.a. congenital tibial dysplasia
70% eventually develop NF
1-2% of NF patients
Osteogenesis Imperfecta (OI)
Defect in type 1 collagen
Radiographic findings (severity) depends on type of OI
Generalized osteoporosis
Thinning of skull, multiple wormian bones, platybasia
Scoliosis, kyphosis, wedging vertebral bodies
Thin gracile bones, bowing bones, pseudoarthrosis, epiphyseal and physeal broadening and irregularity, “popcorn bones”
Multiple fractures of varying ages
Narrow pelvis, protrusio acetabuli
Fibrous Dysplasia
Radiographic findings
Mildly expansile, ground-glass matrix
Well-defined ± sclerotic margins
Monostotic or polyostotic
Ankylosing Spondylitis, Post-Trauma
2-3x more common in males
Approximately 90% HLA-B27 positive
Affects all age groups
Most common in 2nd and 3rd decades of life
Following disruption of fused spine
Radiographic findings
Syndesmophytes
Facet joint ankylosis
Interspinous, supraspinous ligament ossification
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