Malunion Fracture

Malunion is a type of poorly healed broken bone. It happens when the broken parts of your bone grow back together in the wrong position. A malunion fracture can impact your skeleton’s stability. It can also make it hard for you to move or use that part of your body.

Most bone fractures heal well with treatment. If they don’t, it’s because something has affected the healing process. Sometimes, the broken pieces weren’t lined up correctly. Or something prevented your body from healing right.

A malunion fracture is technically healed. But it can limit how well you can use that part of your body. If the bone heals too far out of alignment, you may have a higher risk of breaking it again.

What are the signs and symptoms of a malunion fracture?

You won’t be able to see your bone inside your body. But a malunion fracture can make the affected part of your body look noticeably different. It might look:

• Crooked or bent
• Twisted or rotated
• Shorter than it used to be

You might experience symptoms when you use that body part, including:

• Bone pain
• Swelling
• Limping

Weakness at the malunion can put extra stress on other parts of your skeleton. This may cause pain in another area of your body when you use the injured bone.

If the misshapen bone stretches or pinches a nerve, you might feel:

• Numbness and tingling
• Muscle weakness
• Nerve pain

What causes fracture malunion?

Many factors can contribute to bone fracture malunion, including:

• The type of break: Some fractures are more complicated than others. For example, spiral fractures break your bone with a twisting motion. And comminuted fractures break your bone into many pieces. These have a higher risk of malunion. Traumatic injuries that impact blood flow to the bone can also affect healing.
• How soon and how well it’s treated: A healthcare provider should diagnose and treat a broken bone right away. If not, it may start to heal in the wrong position. Bones can also shift out of place after they’ve been put back in place. This is more likely with delayed treatment. It’s also possible that the original treatment wasn’t right or didn’t work.
• Whether your bone had enough time to heal: It’s important to keep your broken bone immobilized and protected. Sometimes, healing takes longer than usual. Your provider might remove your cast too soon. You can also increase your malunion risk if you use that part of your body too soon.

Malunion risk factors

Lots of factors can increase your malunion risk, including:

• Your age and overall health
• Not getting the right amount of nutrition
• Having diabetes
• Having thyroid disease
• Smoking, vaping or using other types of nicotine

How doctors diagnose malunion fractures

A healthcare provider will check your medical history. They’ll learn about the original injury and any health conditions you have. Your provider will physically examine your bone to look for signs of malunion. They might gently move it. Tell them if any movement or position hurts. Your provider might want to watch you walk or measure the bone’s length.

You’ll need imaging tests to take pictures of your bone, including:

• X-ray
• CT scan
• MRI

Your provider will diagnose malunion if your bone has healed in the wrong position. Healing times can vary based on a few factors, including:

• The original injury
• Which bone has malunion
• Your overall health

Your provider may diagnose malunion six, nine or 12 months after the fracture.

Can malunion fractures be fixed?

Yes, but not all malunion fractures need to be fixed. It depends on:

• How important the bone is
• How much you use it
• How much the fracture impacts your day-to-day life

Malunion can affect your ability to move. It can also hurt. Sometimes, malunion can increase your risk of other complications. In these cases, you might need surgery to fix your bone. Your provider will usually suggest nonsurgical treatment options first.

Treatment for malunion

Nonsurgical treatments for malunion fractures may include:

• Bracing: A brace can help hold your bone in a better position.
• Orthotics: A shoe insert may help even out the length of your legs.
• Physical therapy: Strengthening muscles around the affected bone can take stress off it.
• Pain relievers: Over-the-counter medications, like NSAIDs, can relieve occasional discomfort.

Surgery for a malunion fracture may include:

• Osteotomy: An orthopedic surgeon may need to cut the bone to adjust its position.
• Limb lengthening surgery: This can reshape your arm or leg if malunion makes it too short. Your surgeon may attach a lengthening device.

What can I expect after malunion fracture treatment?

Both nonsurgical and surgical treatments have high success rates. But healing and rehab take time. You may need to use a cane or walker while healing. You’ll need physical therapy, too.

The treatment may fail if the bone doesn’t stay in position or if your provider can’t manage the condition that caused the malunion.