Ankylosis Bony

Ankylos oz is a partial or complete inflexible joint block.

Ankylosis is not the fusion of the ends of the bones that form a joint, but only a joint with a similar fusion resulting from pathological processes. Ankylosis is one of the manifestations of such processes, expressed by the formula: “Preserved joint + bone fusion.” They can form as a result of inflammation of the joint or a fracture of one of its bones due to a purulent process, trauma, prolonged dislocation, neoplasm, or as a result of degenerative changes after a dislocation or chronic combined deformity. The so-called false ankylosis can develop without dislocations and fractures, for example, as a result of fibrous adhesions (scars) that have arisen in the joint area. In congenital combined clubfoot, the normally extended angle between the distal thigh and lower leg ranges from 20° to 30°, but with pathological changes it is often shortened or remains unbent at all (258).

Classification. Depending on the nature of the clinical manifestations, they are distinguished: functional - does not interfere with the function of the joint and is compensated by it; wedge-shaped - causing imbalance and forced positioning of joints; subluxated - with reduced range of motion. Very rarely, formal ankylosis is determined, which does not ensure the safety of the support. According to etiology, primary ankylosis is distinguished: chronic post-traumatic; aseptic (fibrous) traumatic); secondary; areflex; reflex periodic; tertiary dystrophic; necrotic; juvenile (necrotizing).

Clinic. In the functional form there are no symptoms. This can be suspected by an altered gait, the presence of local signs of muscle hypertrophy, disruption of the adhesion of soft tissue to bone protrusions and other minor signs. The condition can be identified using functional tests of Valsalva, Marie, etc. Preservation of freedom of movement and the absence of a pathological axis give rise to diagnostic doubts. Treating the pain syndrome and gradually improving the general condition also sometimes helps to draw a conclusion about the nature of the clinical manifestation of functional forms. It is relatively easy to establish symptoms of the functional form of the secondary characteristic posture of support on the diseased limb when the patient lifts the limb of the same name, often even without pain, when trying to lift it from a lying position. To confirm the diagnosis, an electromyographic study of muscles and other functions of different parts of the musculoskeletal system, and a study of peripheral blood are performed.

An old functional form can be confirmed by: disturbances in static balance, incorrect formation of gait, forward tilt of the torso, fixation of the lower limb in a neutral position of flexion and adduction, functional shortening of the lower limb up to 5 cm. A convincing conclusion can be achieved by performing the Ockhoff and Lassègue test. An important criterion for chronic functional ankylosis is atrophy of the femoral muscles of vertebrogenic origin. Partial or complete anesthesia of peripheral nerves is detected; hypertonicity of the muscles of the limbs; narrowing of joint spaces; ectatic joint