Mal-unions occur when bones heal after a fracture in an awkward position. This condition usually occurs if a bone is held or stabilized incorrectly or is not treated at all and left out of place. Patients feel pain and swelling in the area around the fracture and may have trouble placing weight upon the joint, or above or below the fracture area. Most of the time, patients may just notice an unacceptable bend in their bone.
When Dr. Louis sees a patient with a mal-union, he reviews the patient’s health history, initial treatment and any complications of the treatment. He will also evaluate the patient’s gait and general mobility and observe appendage length. X-rays are always needed, but most malunions often require CT scans for further evaluation and surgical planning. MRIs are necessary to diagnose other complications, such as ligament and cartilage injuries.
Treatment for non-union and mal-union may include the following:
- Internal fixation (link to internal fixation)
- External fixation (link to external fixation)
- Combined internal and external fixation
- Bone grafting
- External bone stimulation, using treatment methods such as ultrasound or electromagnetic therapy
Mal-unions are treated by surgically breaking the malunion (osteotomy), realigning the pieces, and then stabilizing them with plates and screws, a rod, or even an external fixator.
Treatment of non-unions may be complemented with a synthetic bone graft or one that is obtained from the patient or from another individual (also known as a donor graft). Newer approaches are using special proteins called recombinant bone morphogenic protein and bone marrow aspirates. Bone marrow may be harvested from the individual’s pelvic bone or femur and injected directly into the fracture site guided by external imaging. If there is an infection, it will require surgical removal of any infected bone or tissue, followed by intensive antibiotic treatment.
Both conditions often require a long healing period after surgery, and depending on the physical condition of the patient and the extent of the complication, it can sometimes take a few surgeries to fix the problem. Rehabilitation often requires a patient to not bear weight on the affected leg for several weeks, similar to when the initial injury occurred.