When discussing complex reconstructions in previous blog posts, we’ve focused on conditions related to prosthetics, infections, and blood supply. On top of those already discussed, there is another fairly common condition that often results in a complex reconstruction being required: a malunion or non-united fracture.
In many ways, a malunion is a broad condition and can occur in virtually any patient following a fracture. Whereas many of the previously-discussed conditions require that an individual have a prosthesis or joint replacement, or experience a serious blood flow complication, a malunion is much more far-reaching.
In this blog, we hope to answer some of the most important high-level questions about malunions and highlight some common forms of treatment.
In short, a malunion occurs when a fracture doesn’t heal properly. Most often, this means that there was a gap between the two healing bones where no bone grew, rather than the two healing bones joining correctly. This can occur in joints but is not limited to joints.
Because new bone has grown in, complications occur. In a joint, mobility may be severely limited. In an extremity, you may see twists or bends, especially in fingers.
The causes of a malunion are broad, but most often it’s the result of not seeking medical treatment soon enough after a fracture (or not seeking it at all), removing a cast or other immobilizing tool too early, or not aligning bones properly during the immobilization process.
In addition to the bends and limited movement we discussed a moment ago, malunions are quite painful and can result in the deterioration of bones.
There are symptoms of a malunion that are fairly universal, and some that are specific to the malunion occurring in a joint or in an extremity.
We’ll begin by discussing the universal symptoms, which include pain and swelling around an area where a fracture should have healed. The area near the pain and swelling will be extremely sensitive to weight and motion, regardless of whether or not it is a joint.
In joints specifically, movement will be very limited due to pain and the existence of new bone. In the wrist, for example, an inability to flex and extend may impede normal use. Generally, the joint will be painful and stiff.
In limbs & extremities, bends and rotation will often occur. With fingers, in particular, you may see angling more toward or away from neighboring fingers.
Diagnosis is made through a combination of imaging techniques, which may include x-ray, MRI, and/or CT scanning. Once a diagnosis is made, revision surgery may be recommended. All fractures are slightly different, and accordingly, all malunions are slightly different. This means there is some variance in how malunions are treated surgically.
The revision surgery may involve a change of hardware, bone grafting, or microsurgery to place a vascularized fibular graft. Ultimately, the goal of the surgery is to realign the previously fractured bones and remove any excess bone growth. The use of new hardware, such as screws, plates, or pins, may be employed to virtually guarantee alignment.
Following surgery at GDO, we create a post-operative care plan to ensure the long-term success of the re-aligned fracture that is unique to each patient.
Like all conditions we discuss here, the key to success is early diagnosis. If you or a loved one is experiencing the symptoms of malunion in the area directly surrounding a previous fracture, schedule a consultation as soon as possible.
Revision surgery for a malunion fracture is varied and requires extreme precision, which why patients and referring physicians trust GDO. We are the recognized regional experts in malunion revision surgery, providing us the expertise necessary to optimize outcomes.