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Malunions: Causes, Symptoms and Surgical Solutions

Malunions occur when fractures heal in an incorrect anatomical alignment or position. At University Orthopaedic Associates (UOA), we can help you determine whether your symptoms are being caused by a malunion and discuss your available treatment options. Malunions can be successfully treated with orthopaedic surgery.

What Is a Malunion?

A malunion is a fracture (or broken bone) that has healed abnormally. It is not the same as a nonunion, which is a fracture that does not heal after treatment.

All fractures have the potential to result in a malunion, which is repairable with orthopaedic surgery. Malunions are treated by an array of orthopaedic procedures to help the bones achieve and maintain their correct positions and alignment.

What Causes a Malunion?

Malunions can occur when a bone is shortened by an injury or has twisted or rotated after being set. They may also occur when a fracture has displaced the surface of a joint, which causes the cartilage in the joint to become rougher. These changes can often lead to joint pain and degeneration, including arthritis.

A malunion can happen after any type of fracture, though they are more likely to happen after a complex fracture. Examples of complex fractures are when bones have broken into multiple pieces or rotated at the time they broke. Malunions can also occur during the healing process, such as when bones start healing before they are properly aligned, or when they fall out of alignment after being set. A bone infection can also interfere with the healing process of fractures to cause malunions.

Malunion Risk Factors

Certain factors can increase your risk of developing a malunion. These risk factors include obesity, tobacco use, alcohol use and medical conditions like diabetes that can slow healing or that can cause your bones to heal improperly. If you suffer a fracture, the experts at UOA can talk to you in greater detail about how to reduce your risk for a malunion and ensure your fracture heals properly.

Symptoms of Malunions

Malunions can cause a variety of symptoms based on their location and severity. Common symptoms of malunions include:

  •     Swelling, pain, stiffness and/or tenderness around the fracture site
  •     Deformity
  •     Bend or rotation of the fractured bone
  •     Limited range of motion
  •     Altered use or function of the affected limb
  •     Partial or full loss of limb movement or function
  •     Difficulty bearing weight
  •     A limb that appears to be short, twisted or curved compared to the opposite limb

Treatments for Malunions

Malunions can be diagnosed with a physical exam, a review of your medical history and imaging procedures including X-ray, computed tomography (CT) scan and magnetic resonance imaging (MRI). Your specialist may talk to you about your symptoms and about the fracture that caused the malunion.

Malunions are typically treated using orthopaedic surgery. The goal of surgery is to correct the misaligned bone and remove any excess bone growth that is causing a deformity or other symptoms. The exact surgical technique used will vary based on factors including the location of the malunion, its severity and your symptoms.

In some instances, your surgeon may realign the fracture and trim away parts of the bone so the fracture can be properly realigned. Malunions that lead to the shortening of bone may require a bone graft to lengthen the bone. Surgery may also include the placement or insertion of hardware including screws, plates, rods or external fixators, which can help your bone stay straight and in the proper alignment as it heals.

Post-Operative Care

Following your surgery, your physician will work with you closely to ensure your fracture heals properly without causing another malunion. 

Your post-operative care may include wearing a cast or splint, avoiding weight-bearing activities and attending follow-up appointments where your physician  can monitor your healing progress using an X-ray, CT scan or MRI. Occupational therapy or physical therapy may be necessary to help you regain function of the affected bone or joint. At UOA, we offer rehabilitation services on site. 

If you think you may be experiencing symptoms of a malunion, contact UOA to schedule an appointment with one of our trauma and fracture care specialists. We can perform an evaluation and develop a customized treatment plan that can help you get your life back in motion.