Deformities: Malunion

What malunion and bone deformity are

When a fracture heals with the fragments out of their original alignment, the bone is united but its shape has changed. That change takes several forms, often in combination: angulation, where the bone is bent; rotation, where one segment is twisted relative to the other; and shortening, where length has been lost. Deformity does not always follow a fracture. It can also result from a growth plate injury in childhood, a bone infection, previous surgery, or a congenital condition.

Limbs work as linked chains, so a deformity in one segment shifts how load passes through the joints above and below it. A bone healed at an angle can concentrate pressure on one part of a joint surface rather than spreading it evenly. Some malunions are noticeable mainly as a difference in appearance; others interfere with walking or gripping, and may contribute to pain that develops long after the injury healed.

Symptoms that often bring people in

• A limb that looks bent, twisted, shorter or different from the other side
• Pain in a joint above or below an old fracture rather than at the fracture itself
• A limp or altered gait
• Loss of forearm rotation, or difficulty positioning the hand for daily tasks
• Reduced range of motion, or a sense of the limb catching at the end of movement

How deformity is evaluated

Assessment combines clinical findings with careful measurement on imaging. Examination looks at standing alignment, joint mobility above and below the deformity, and how the limb behaves during walking. Imaging typically includes X-rays capturing the whole limb rather than one segment, since alignment can only be judged against the joints at either end. CT is often useful for defining rotation, which is difficult to measure on plain films.

Treatment options in general terms

Deformity does not always require correction. Where symptoms are mild or the change in shape is well tolerated, non-surgical measures may be considered first.

• Observation. A deformity causing no symptoms may simply be monitored, with attention to whether nearby joints are affected over time.
• Shoe modification and orthotics. Lifts, inserts or bracing can compensate for length differences or redistribute load.
• Therapy. Work on strength, flexibility and gait may help manage the demands a deformity places on surrounding joints.

Surgical correction may be discussed when a deformity causes pain, limits function, or appears to be placing a joint at risk.

• Osteotomy. The bone is cut in a planned way and repositioned into corrected alignment, then held with internal fixation while it heals.
• Gradual correction with an external frame. A circular frame allows alignment, rotation and length to be adjusted in small increments over time, using the principles of the Ilizarov method. This is often considered when the correction is large or combined with lengthening.
• Combined reconstruction. Where deformity accompanies a fracture that never united or previous infection, correction may be planned together with treatment of those problems.

What to expect when you consult Dr. Wolfson

Dr. Wolfson trained in the Ilizarov method of limb lengthening, reconstruction and deformity correction, and treats patients whose fractures healed in poor position or who have deformity following infection or earlier surgery. A consultation usually begins with a full-limb assessment, because the goal of correction is a limb that works as a whole. Related pages cover nonunion and leg length difference.

This page provides general information about malunion and limb deformity and is not medical advice. It is not a substitute for examination, imaging and diagnosis by a qualified physician. Every case is different and requires individual evaluation. If you have severe pain, an obvious deformity, loss of function, fever, or an injury from a significant accident, seek medical care promptly.

Contact Dr. Wolfson if you would like to setup an appointment. If you are a new patient, please book all in-person appointments with Dr. Wolfson via telephone.

If you live outside of the San Francisco Bay Area, you can request a complimentary phone consultation with Dr. Wolfson to assess your case. Please call or e-mail us to set up your complimentary consultation.

Call: (415) 221-4400

E-mail: [email protected]