Malunion / Nonunion Correction
Medical term: Fracture Malunion and Nonunion
Overview
A malunion occurs when a fractured bone heals in an abnormal position, resulting in deformity, malalignment, or functional impairment. A nonunion occurs when a fracture stops progressing toward healing, leaving the bone permanently broken. Both conditions can cause chronic pain, difficulty with movement, and problems in nearby joints due to altered biomechanics.
At our San Diego orthopedic trauma practice, we evaluate and treat patients whose fractures have not healed as expected. Whether a prior fracture healed crookedly or has not healed at all, our surgeons use advanced techniques including corrective osteotomy, bone grafting, and specialized fixation to restore alignment and promote healing. Many patients who come to us for malunion or nonunion correction have been told their options are limited, and we take pride in offering thorough second opinions and individualized surgical plans.
Causes
Malunion and nonunion can result from a variety of factors related to the initial injury and its treatment:
- Inadequate initial fixation — if the bone was not stabilized sufficiently, it may shift during healing or fail to heal altogether
- Severe fracture patterns — high-energy injuries with significant bone loss or soft tissue damage are at higher risk
- Infection — infection at the fracture site can disrupt the healing process
- Poor blood supply — certain bones and fracture locations have limited blood flow, making healing more difficult
- Patient factors — smoking, diabetes, poor nutrition, and certain medications can impair bone healing
- Premature return to activity — excessive loading before the fracture has healed can cause displacement or prevent union
Treatment Options
Treatment depends on whether the problem is a malunion (healed in the wrong position) or a nonunion (not healed at all), and on the location and severity of the deformity.
Malunion Correction
- Corrective osteotomy — the bone is surgically cut at or near the site of the malunion, realigned into the correct position, and stabilized with plates, screws, or an intramedullary nail
- Gradual correction — for complex deformities, an external fixator or multiplanar frame may be used to slowly adjust alignment over weeks
Nonunion Treatment
- Revision fixation with bone grafting — the nonunion site is surgically refreshed, bone graft is applied to stimulate healing, and stable fixation is applied
- Bone stimulators — in select cases, electrical or ultrasound bone stimulation may be used as an adjunct to promote healing
- Infection management — if infection is contributing to the nonunion, it must be addressed with debridement and targeted antibiotics before definitive fixation
When to See a Doctor
If you have persistent pain, deformity, or difficulty using a limb months after a fracture, it is important to be evaluated for malunion or nonunion. Contact our San Diego office for a thorough assessment. Early intervention can prevent further joint damage and improve long-term function.