Malunion is said when fracture fragments heal in an abnormal position.
the causes of malunion can be :
- Improper immobilization of the fracture can lead to complications, as can inadequate immobilization for insufficient durations.
- Because closed reduction is a blind technique, accurately assessing the reduction is often challenging, leading to common occurrences of this issue in treated fractures.
- If quacks administer the treatment, their poor understanding of fracture anatomy can lead to this complications.
- the osteopaths and the traditional bonesetters contribute significantly to the incidence of malunion
- multiple and multisystem injury can be life threatening and assume more importance during treatment
- the fractures may go unnoticed by the treating physician resulting in malunion
Classification of Malunion
- Length : this commonly results in shortening of the limb and rarely may give rise to lengthening
- Rotatory : this may cause external or internal rotation deformities.
- Angulatory : this may cause varus or valgus deformities
Clinical Features of Malunion
- A individual with malunion of bones may complain of deformity .
- there may be alteration or loss of function of affected extremities.
- it may cause shortening and wasting of involved limbs
- it may also cause cosmetically unsightly deformity
- alteration in posture and balance in lower limb fractures.
Radiography of the affected part, including the joints above and below are mandatory to assess the malunion.
Treatment for the same
If the patient has no functional problems cosmesis alone does not form a sufficient indication for surgery unless the patient desires so.
nevertheless, operative treatment is highly justified when malunion affects the function.
this can be done by corrective osteotomy at the old fracture site or a compensatory procedure may be necessary to restore functions
for example : Darrach’s operation in malunited colles
sometimes pain be the only predominant symptom necessitating fusion of the affected joint.
the optimum time to carry out surgery for this is 6-12 months after the fracture has occurred.