Malunion Fracture

What is a malunion fracture?

A malunion fracture is a broken bone that heals abnormally. As a result, the limb may be bent, twisted, or both. Depending on which bone is involved and how severely the bone is out of alignment, a malunion can impair function and mobility in the affected limb.

A malunion is different from a nonunion. Nonunions are fractures that do not heal despite treatment. Nonunions most often occur when the blood supply to the injured area is too low to support healing or as the result of infection or other complications.

How do bones heal?

Typically, broken bones are set and then stabilized with a cast, splint, or boot. Most of the time, fractures heal without any problem after treatment. Bone healing takes place in stages:

  • Inflammation: Soon after the bone breaks, a blood clot forms around the fracture to project the injury.
  • Repairing: In the next stage, tissue grows around the ends of the fractured bone until the ends meet. This tissue, known as callus, stabilizes the bone and is later replaced by spongy bone tissue.
  • Bone remodeling: Over time, spongy bone is replaced by solid bone. The area around the fracture site may remain swollen for a while, but over time, new bone grows into the shape of the original bone.

What are the symptoms of a malunion?

The symptoms of a malunion depend on which bone is affected and the severity of the malunion. They may include:

  • partial or full loss of limb movement
  • partial or full loss of limb function
  • limping that persists after a leg fracture has healed
  • swelling, pain, and tenderness around the fracture site
  • painful joints near the fracture site (for instance, a painful wrist or elbow could be a symptom of a a malunion in the forearm)
  • a limb that appears twisted, curved, or short compared to the opposite limb

How M&M cookies led to a malunion realization

For nearly 10 years, Tyler's parents and coaches didn’t know he could not rotate his left arm due to a malunion fracture.

Boy holds trophies after baseball tournament

What causes a malunion?

Malunion fractures are often the result of a complex fracture. For example:

  • A comminuted fracture is a type of complex fracture in which the bone has broken into multiple pieces.
  • An angulated fracture is a fracture in which the two ends of the bone are at an angle to each other.
  • A rotated fracture is one in which the bone rotated when it broke, leaving the two ends of bone out of alignment.

These and other complex fractures are more difficult to treat and pose a higher risk that the bone will heal out of alignment.

Malunions can also occur during the healing process. Possible causes include:

  • The fracture does not receive medical treatment right away, and the bone starts healing before the pieces are aligned.
  • The bones are set out of alignment.
  • The bones become unaligned after being set.
  • A bone infection (osteomyelitis) complicates the healing process.

How we care for malunions at Boston Children’s Hospital

The Limb-Lengthening and Reconstruction Program at Boston Children’s Hospital provides comprehensive care for children and young adults with malunions and many other limb disorders. Our team includes experts from our Lower Extremity Program and Hand and Orthopedic Upper Extremity Program with deep expertise in both non-surgical care and limb-lengthening and reconstruction procedures.

We have treated thousands of babies, children, and young adults with conditions that range from routine to highly complex limb differences. We also offer the benefits of the extensive services available at Boston Children’s, as well as some of the most advanced clinical and scientific research in the world.

We’ll work with you and your child to review the available options and decide the best course of treatment based on your child’s individual needs.