Malunion and Nonunion Treatments
What Is Bone Union, and Why Does It Matter?
After a fracture, the body's natural repair process begins to ensure correct bone healing. Sometimes, however, this process does not work as it should, and the bone either heals in the wrong position (malunion) or fails to heal (nonunion).
These conditions may cause both functional problems and chronic pain. Malunion or nonunion, particularly in the lower limbs, can affect balance when walking and lead to long-term joint problems in the knees, hips and lower back.
What Causes Malunion and Nonunion?
⚠ Incorrect Treatment: Malunion may occur if a fracture is not properly stabilized.
⚠ Inadequate Blood Flow: Factors such as diabetes, vascular disease or smoking may impair circulation and prevent bone healing.
⚠ Insufficient Mechanical Stability: Incorrect use of plates or screws may prevent proper bone healing.
⚠ Infection: Bone infections (osteomyelitis) can severely impair bone union.
⚠ Inadequate Nutrition: Calcium, vitamin D and protein are needed for bone healing. Nutritional deficiencies may prolong recovery.
Treatment Methods for Malunion and Nonunion
Nonsurgical Treatments
The following methods may be tried in some mild cases of nonunion:
Extracorporeal Shock Wave Therapy (ESWT): Sound waves stimulate bone healing.
Bone Stimulation Devices: Electrical or magnetic fields support bone growth.
Biological Agents: PRP, stem cell treatments or bone growth factors may be used.
However, surgery is unavoidable in advanced cases.
Surgical Treatment Methods
Osteotomy and Realignment
- The malunited bone is surgically cut and repositioned correctly.
- It is stabilized with a plate, screws or an external fixator.
Bone Grafting
- A graft from the patient's own bone or synthetic materials is added to stimulate bone union.
- It is particularly effective in atrophic nonunion.
External Fixator (Ilizarov or Taylor Frame)
- Gradually corrects and realigns bones with nonunion or malunion.
- If bone loss is present, bone may be formed through bone transport.
- Infection Treatment (for Osteomyelitis)
- In septic nonunion, the infection is cleared first.
- Infection is controlled with antibiotic-loaded cement or local antibiotic applications.
Recovery after Malunion and Nonunion
Physical Therapy: Physical therapy is essential to strengthen muscles and increase joint mobility.
Nutrition: A diet rich in calcium, vitamin D and protein accelerates bone healing.
Stopping Smoking and Alcohol: Because nicotine adversely affects bone healing, patients who smoke take longer to recover.
Frequently Asked Questions about Malunion and Nonunion
Can a Bone That Has Healed Incorrectly Be Corrected?
Yes. Osteotomy and corrective bone surgery can realign malunited bones.
When Does a Nonunited Fracture Require Surgery?
Fractures showing no healing for more than 6 months generally require surgery.
Does Bone Fully Regain Its Strength after Nonunion Surgery?
Yes, complete bone healing is possible with appropriate treatment and rehabilitation.
What Is the Success Rate in Patients Receiving Bone Grafts?
Bone grafting has an 85-95% success rate in suitable patients.
Nonunion and Its Treatment Methods
Bone fractures can generally heal quickly with medical intervention. In some cases, however, the bones at the fracture site fail to unite over time, prolonging recovery. In medical literature, this is called “failure of bone union” or “nonunion” . Nonunion is an important clinical problem in orthopedics because, if untreated, it can lead to serious consequences such as pain, loss of function and restricted movement.
What Is Nonunion?
When a bone breaks, its ends normally come together and heal by uniting. Sometimes, however, the bones fail to unite. Nonunion means that the bone ends at the fracture site do not come together, do not heal or heal very slowly. Nonunion may be temporal (temporary) or focal (localized) and, if untreated, can cause long-term disability or chronic pain.
Causes of Nonunion
- Poor Blood Circulation: Insufficient blood supply to the fracture site prevents bone healing. For example, recovery is prolonged when blood vessels or nerves are damaged.
- Inadequate Stabilization (Immobilization): Stabilizing the fracture keeps the bones in the correct position. With inadequate stabilization, the bones do not unite properly.
- Infections: Infections at the fracture site may prevent union. Infection makes it harder for bones to join healthily.
- Inadequate Bone Alignment: Fracture angulation or displacement may prevent union.
- Age and Health: Older age, systemic diseases such as diabetes or habits such as smoking can adversely affect bone union.
Symptoms of Nonunion
- Persistent pain at the fracture site
- Restricted mobility
- Bone deformity (curvature, bending)
- A marked reduction in movement
- Slow healing or failure to heal
Treatment Methods
Treatment for nonunion varies with the severity of the condition and the patient's general health. Early intervention can make treatment easier and more successful. Here are some principal methods for treating nonunion :
Surgery and Internal Fixation:
Surgery is generally required to join bones that have not united. The operation uses internal fixation (screws, plates and nails). These devices hold the bone ends in the correct position and promote union. Internal fixation brings the bones back together at the site of nonunion.
Bone Graft (Grafting):
Bone grafting adds new bone tissue to the area of nonunion. The graft may come from the patient's own bone (autograft) or a donor (allograft). It is added to the ununited bone to accelerate healing. Bone grafting is a highly effective treatment for overcoming nonunion.
Advanced Physical Therapy:
For some patients, physical therapy and rehabilitation may encourage union. Special exercises and manual therapy techniques alongside treatment may also accelerate bone healing. However, physical therapy alone may not be sufficient for nonunion.
Electromagnetic Field Therapy (EMS):
Electromagnetic field therapy is used to accelerate bone healing. A low-frequency electrical field is applied to the fracture site. This type of therapy may accelerate healing by stimulating bone cells.
Biological Treatments (PRP, Stem Cell Therapy):
Biological treatments are increasingly used for nonunion.
Platelet Rich Plasma (PRP), is a treatment made by concentrating platelets from the patient's blood. PRP may accelerate bone healing. In addition, stem cell therapy is used as an innovative treatment option for ununited bones.
Conclusion
Nonunion is an important clinical problem in orthopedic practice and can cause serious health problems if not treated correctly. A patient with suspected nonunion should therefore promptly consult an orthopedic specialist. Advances in medical technology and treatment make it possible to resolve nonunion. Treatment is personalized according to age, general health and fracture type. Methods ranging from orthopedic surgery to biological treatments can help patients recover faster and more effectively.
What Is Malunion (An Unhealed Fracture)?
Malunion occurs when a bone does not heal in the correct anatomical position. Curved or incorrect union can cause loss of function.
In malunion, failure to align the bone correctly may cause deformity and loss of function.
It generally results from incorrect treatment, inadequate stabilization, infection or circulation problems. It can cause pain, deformity and restricted movement.
Symptoms of Malunion
Deformity at the fracture site
Restricted movement or loss of function
Chronic pain and tenderness
Walking difficulties due to bending or shortening of the bone
• Persistent pain and tenderness
• Bone deformity
• Restricted movement or loss of function
• Signs of swelling and inflammation
• Abnormal movement in the bone
What Causes Malunion?
• Inadequate stabilization and incorrect fracture treatment
• Insufficient circulation at the fracture site
• Infections after a fracture
• Early movement or excessive loading
• Conditions weakening bone structure, such as osteoporosis
Types of Malunion
1. Atrophic Nonunion: A gap between bone ends without new bone formation.
2. Hypertrophic Nonunion: Thickening of bone ends as they attempt to heal but fail to unite.
3. Pseudarthrosis: Formation of a false joint at the fracture site.
4. Malunion: Healing of bones in the wrong position.
Malunion Treatment Methods
1. Surgical Treatment:
o Revision Surgery: Creating a new fracture to correct a malunited bone and stabilizing it in the proper position.
o External Fixators: Devices such as Ilizarov ensure proper bone union.
o Bone Grafting: Adding bone tissue to areas with absent or weak union supports healing.
2. Medication and Supportive Treatments:
o Medications supporting bone healing (calcium, vitamin D, bisphosphonates, etc.)
o Physical therapy and rehabilitation
3. Minimally Invasive Methods:
o Magnetic field therapy
o Ultrasound stimulation
Malunion Treatment and Recovery · Treatment varies according to the patient, fracture type and healing process. During recovery, which usually lasts several months, patients must follow medical advice fully. Physical therapy and nutritional support are also factors that accelerate treatment.
Conclusion
Untreated malunion can cause serious health problems. With early diagnosis and appropriate treatment, patients can live healthy lives without pain. If your fracture has not healed correctly, consult a specialist to determine the most appropriate treatment.
