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Foot & Ankle Fractures Malunion

Fracture: Malunion fundamentals

"Malunion" is a clinical term used to indicate that a fracture has healed, but that it has healed in less than an optimal position. This can happen in almost any bone after fracture and occurs for several reasons.

Malunion may result in a bone being shorter than normal, twisted or rotated in a bad position, or bent. Many times all of these deformities are present in the same malunion.

Malunions can also occur in areas where a fracture has displaced the surface of the joint. When this happens, the cartilage in the joint is no longer smooth. This may cause pain, joint degeneration, "post-traumatic arthritis" or catching or "giving-way" episodes resulting from instability or incongruency of the joint.

What are the symptoms?

  • Swelling
  • Pain
  • Tenderness
  • Deformity
  • Difficulty bearing weight

What are my treatment options?

In almost all situations, treatment involves cutting the bone, at or near the site of the original fracture. The cut or “osteotomy” is done to correct the mal-alignment. In addition, some secure method of fixation must be used to hold the bones in the desired position. This fixation may require plates, rods, or an external frame with pins.

Malunions that include shortening of the bone often require some method for bone lengthening.

What are the risks of surgery? 

Risks include nerve injury, infection, bleeding, and stiffness.

How do I prepare for surgery?

  • Complete any pre-operative tests or lab work prescribed by your doctor.
  • Arrange to have someone drive you home from the hospital.
  • Refrain from taking aspirin and non-steroidal anti-inflammatory medications (NSAIDs) one week prior to surgery.
  • Call the appropriate surgery center to verify your appointment time. If your surgery is being done at Cleveland Clinic, call 216.444.0281.
  • Do not eat or drink anything after midnight the night before surgery.

What do I need to do the day of surgery?

  • If you currently take any medications, take them the day of your surgery with just a sip of water.
  • Do not wear any jewelry, body piercing, makeup, nail polish, hairpins or contacts.
  • Leave valuables and money at home.
  • Wear loose-fitting, comfortable clothing.

What happens after surgery?

Elevate your upper body while you sleep and take acetaminophen for pain. If wearing a cast, apply heat to the injured area to improve blood circulation and promote healing. After the cast is removed, massage the injured area with ice.

Finally, follow a nutritious diet and exercise the non-affected muscle groups to maintain your overall health during the recovery process. Most importantly, avoid smoking, as nicotine has been shown to inhibit fracture healing. Additionally, avoid, if possible, radiation therapy, chemotherapy, NSAIDs and systemic corticosteroids, as all of these treatments are known to slow the bone-healing process.

Ask your surgeon for complete post-operative instructions.

How long is the recovery period after surgery?

Your doctor will use an X-ray to determine whether the fracture has fully healed. The X-ray will determine how long the recovery is.

What is the rehab after surgery?

Your doctor will provide instructions regarding weight bearing and physical therapy.

How can I manage at home during recovery from the procedure?

Activity at home will depend upon your doctor’s instructions.

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