Overview
Fracture malunion occurs when a fractured bone heals in an improper position, leading to functional impairment and pain. Treatment aims to correct alignment and restore function, often through surgical intervention like osteotomy 12.Diagnosis
Clinical assessment focusing on deformity, pain, and functional limitations.
Radiographic evaluation including X-rays to assess malalignment and joint spaces.
Bohler angle and talocalcaneal height measurements are crucial in calcaneal malunions 1.Management
First-line treatments:
- Corrective osteotomy for anatomical realignment 12.
- In distal radius malunions, osteotomy is preferred over ligament repair for dynamic midcarpal instability 2.
Adjunctive treatments:
- Post-operative immobilization with casting or splinting.
- Physical therapy to restore function and strength 2.Special Populations
Pediatrics: Specific considerations for growth plate involvement not addressed in abstracts.
Elderly: Increased risk of complications; careful assessment of surgical risks advised 2.
Comorbidities: Presence of post-traumatic arthritis may necessitate arthrodesis instead of osteotomy 2.Key Recommendations
Perform corrective osteotomy for symptomatic malunions to improve anatomical alignment and function (Evidence: Moderate 12).
In cases of distal radius malunion with dynamic midcarpal instability, prioritize osteotomy over ligament repair or intercarpal arthrodesis (Evidence: Moderate 2).
Consider patient-specific factors such as age and comorbidities when deciding between osteotomy and arthrodesis (Evidence: Expert opinion 2).References
1 Guan X, Xiang D, Hu Y, Jiang G, Yu B, Wang B. Malunited calcaneal fracture: the role and technique of osteotomy-a systematic review. International orthopaedics 2021. link
2 Amadio PC, Botte MJ. Treatment of malunion of the distal radius. Hand clinics 1987. link