Post-traumatic Deformity (nonunion, malunion)

Nonunion

A fracture is a break in the bone that occurs when extreme force is applied. Treatment of fractures involves the joining of the broken bones either by immobilizing the area and allowing the bone to heal on its own, or surgically aligning the broken bones and stabilizing it with metal pins, rods or plates. Sometimes, the broken bone fails to rejoin and heal even after treatment. This is called nonunion. Nonunion occurs when the broken bones do not get sufficient nutrition, blood supply or adequate stability (not immobilized enough) to heal. Nonunion can be identified by pain after the initial fracture pain is relieved, swelling, tenderness, deformity and difficulty bearing weight.

When you present with these symptoms, your doctor may order imaging tests like X-rays, CT scans and MRI to confirm a diagnosis of nonunion. The treatment of nonunion fractures can be achieved by non-surgical or surgical procedures.

Non-surgical treatment: This method involves the use of a bone stimulator, a small device that produces ultrasonic or pulsed electromagnetic waves, which stimulates the healing process. You will be instructed to place the stimulator over the region of nonunion for 20 minutes to a few hours every day.

Surgical treatment: The surgical method of treatment for nonunion is aimed at:

• Establishing stability: Metal rods, plates or screws are implanted to hold the broken bones above and below the fracture site. Support may be provided internally or externally.
• Providing a healthy blood supply and soft tissue at the fracture site: Your doctor removes dead bone along with any poorly vascularized or scarred tissue from the site of fracture to encourage healing. Sometimes, healthy soft tissue along with its underlying blood vessels may be removed from another part of your body and transplanted at the fracture site to promote healing.
• Stimulating a new healing response: Bone grafts may be used to provide fresh bone-forming cells and supportive cells to stimulate bone healing.

Malunion

A malunion occurs when the fractured ends of a bone heal in an abnormal position. It can result in bending, rotation or shortening of the bone with loss of function.

Immobilization of the fractured bone is a critical step in proper bone healing. Malunions may be caused by inadequate immobilization of the fracture areas, improper positioning during immobilization or bone loss during the injury.

A malunion may be associated with pain, tenderness, swelling, deformity or difficulty bearing weight. If a malunion involves a joint, it can result in an irregularity of the smooth cartilage which interferes with movement producing pain, swelling and degeneration (arthritis).

When you present with symptoms of a malunion, your doctor will review your history and perform a physical examination. Imaging studies such as X-rays, CT scan, MRI scan or bone scan may be obtained for a more detailed view.

Your doctor may suggest not treating a malunion that does not affect function or have any other adverse effects. If treatment is necessary, it usually involves surgery to cut the bone (osteotomy), reunite the fragments in the correct position and secure it with pins attached to an external frame, wires, rods, plates and/or screws.