Malunions: Introduction and Brief Overview

Although the diagnosis of a malunion is fairly straightforward, the evaluation and management can be somewhat challenging. In both the upper and lower extremities, a malunion can result in severe functional problems. Due to the weight-bearing requirements of the lower extremity, malunions can lead to gait disturbances, low back pain, and even the development of post-traumatic arthritis which can be debilitating. In managing these malunions, a thorough understanding of the factors that can lead to a malunion is required, both in general principle and in particular as related to the specific area involved. Although many malunions can occur due to neglect (lesser developed countries) or nonoperative management, patient factors as well as surgical factors can come into play. It is important to understand how malunions can be classified which can guide treatment principles. The evaluation requires a history of the original injury including the treatment rendered, medical history of the patient to include a social history with regard to habits, and a careful physical exam. A critical analysis of the original treatment is required. If operative intervention was performed, the implants used should be critically evaluated as to the technique and appropriateness of the fixation construct. Appropriate radiographs, laboratory studies, and advanced imaging may be warranted. Infection must always be suspected and ruled out. The corrective osteotomy must be carefully planned out by type and location as well as method of stabilization for a successful outcome.