What is Malunion and How is It Treated?

Malunion, known in medical literature as "malunion," occurs when fractured bones fail to heal in an anatomically or functionally appropriate position. This condition arises from errors during the natural healing process or insufficient treatment. If the bone deviates from its proper alignment during healing, malunion develops. This can cause both functional limitations and aesthetic issues.

Malunion typically happens when the fracture is not adequately stabilized or treated correctly. When the fracture ends do not fully contact each other, the healing may result in angular, rotational, or axial misalignments. Consequently, patients may experience restricted movements in the affected limb, deformity, pain, and potentially decreased joint function over time.

Causes of Malunion

Several key factors contribute to malunion:

Treatment Inadequacy: Post-fracture treatment may lack sufficient stability. Improper use of casts, fixation devices, or surgical methods can cause movement at the fracture site, leading to misalignment.
Fracture Type and Location: Certain fractures, especially comminuted (multi-fragmented) fractures or those near joints, pose challenges to proper alignment.
Early Movement or Stress: Premature loading or uncontrolled movements during treatment can cause fracture ends to shift.
Soft Tissue Problems: Injuries to surrounding muscles, tendons, or skin may negatively impact healing.
Infections or Other Complications: Presence of infection may delay or disrupt bone healing.

Symptoms of Malunion

Clinical signs indicating malunion include:

Angular Deformity: The bone appears crooked or bent due to misalignment.
Length Discrepancy: The bone may appear shorter or longer, causing limb length differences.
Loss of Function: Reduced range of motion in affected joints, especially weight-bearing limbs, may cause walking difficulties.
Pain and Tenderness: Persistent pain around the fracture site, intensifying with activity.
Cosmetic Issues: Visible deformities due to anatomical misalignment.

Diagnosis of Malunion

Malunion diagnosis primarily relies on physical examination and imaging studies. X-rays serve as essential tools to identify angular and axial deformities. When necessary, computed tomography (CT) scans provide three-dimensional assessment. The patient's complaints and functional impairment are also evaluated to reach a treatment decision.

Treatment Approaches

Treatment for malunion depends on factors such as the type and severity of deformity, the patient’s age, and overall health condition. Treatment options include:

Conservative Treatment: Observation or physiotherapy may be advised in mild deformities without notable functional loss; however, this approach is limited.

Surgical Treatment:

Osteotomy: The most common method involves surgically cutting the incorrectly healed bone to realign and stabilize it.
Ilizarov Device and Limb Reconstruction: A circular external fixator is used to achieve bone lengthening and realignment, especially in complex deformities.
Bone Grafting and Infection Management: If infection accompanies nonunion, antibiotics and surgical debridement may be required.
Prosthetics and Joint Surgery: In cases where the deformity affects joint surfaces, prosthetic replacement might be considered in resistant situations.

Advances in computer-assisted surgical planning and minimally invasive techniques have improved success rates in malunion treatment. Early diagnosis and appropriate management maximize functional recovery.

Prevention of Malunion

Proper alignment of fractures, stable fixation, appropriate physiotherapy, and regular follow-up are vital to preventing malunion. For high-risk fractures, support from experienced orthopedic centers is recommended.

A multidisciplinary approach involving orthopedic surgeons, physiotherapists, and infection specialists is critical to enhance the patient’s quality of life and minimize complications.