About Post Traumatic Malunion Nonunion

Definition: post traumatic malunion and non-union are still prevalent in general population. Malunion means union of bone in incorrect anatomical alignments. Non-union means failure to union in broken bone. Delayed union means union of fracture takes longer than usual to heal. 

   Etiology: Malunion can occur because of conservative approach and sometime even after surgery. Malunion cause deformity that hamper proper functioning of extremity and some time it is quite disabling. Non-union occurs because of many reasons. In which improper fixation, abnormal bone biology, osteoporosis & infection, high energy trauma with vascular impairment of affected bone is the common causes? Other risk factor are tobacco, nicotine, very low Vit D, sever protein malnutrition, anti-inflammatory drugs, compound injury etc. Non-union mostly occur in adult but rare in children except few places like elbow (fracture lateral condyle humerus) and hip joint (fracture neck femur). Malunion are very common in children as well as adult. In children bone unite very fast so if properly not managed then they may get malunion. 

Prognosis: Due to remodeling property in children, up-to certain extent malunion get corrected with age. Early the age and near to joint get faster remodeling and faster correction of malunion.  But injury to physial growth plate at the end of bones can cause progressive increase in deformity and shortening of limb. Malunion in diaphysis away from physial growth can cause disabling deformity in children also. Malunion in adult is not acceptable as it cause disability and never correct due to absence of remodeling. 

Diagnosis: diagnosis of malunion, nonunion and delayed union can be made on the basis of x-ray & clinical examination.  Some time we need advance imaging modality like CT scan and MRI

Prevention: prevention is better than cure. Nonunion, delayed union & malunion can be prevented in most of the patients. Biological cause are more resistant to treatment. Early and good modality of treatment can prevent most of the nonunion and malunion. If biology of bone and surrounding soft tissue is poor then it should be strengthen. Treatment of associated bone metabolic abnormality like osteoporosis, vitamin d deficiency help the lot to these patient.  

Treatment:  Treatment of non-union is based on cause. If bone stability is not good after surgery then they may need revision surgery. Supplements in the form of calcium, vitamin D, Vit C and protein is must to enhance the speed of union.   During surgery most of time nonunion need bone grafting & implant.  With the modern methods of treatment including revision surgery by plating, nailing, Ilizarov, bone supplements etc. both problem can be managed successfully in most of the cases. 

Malunion: if malunion occurs because of non-operative treatment then they need surgery to correct the deformity. After correction of deformity most of time they need fixation by various means including wire, plate, nail, fixater. If malunion occurs after surgery with implant in situ then they need implant removal followed by osteotomy and fixation of bone.