Malunion and Non-union Bone Treatment
Corrective treatment for fractures that healed improperly or failed to heal.
Most fractures heal within a few months, but occasionally a bone heals in the wrong position (malunion) or fails to heal at all (non-union). Both situations usually follow an earlier fracture that did not fully stabilise or align during the original healing period, and both often need a second, more deliberate round of treatment to correct.
Types
Malunion
The fracture has healed, but in a bent, rotated, or shortened position that affects the limb's alignment or function.
Delayed Union
The bone is healing, but taking noticeably longer than expected for that type of fracture.
Hypertrophic Non-union
The bone ends show extra bone formation but never bridge together, usually because of excess movement at the fracture site during healing.
Atrophic Non-union
The bone ends show little to no healing activity at all, often linked to poor blood supply at the fracture site.
Infected Non-union
A non-union complicated by ongoing infection at the fracture site, which needs to be treated before the bone can heal.
Common Causes
Malunion and non-union usually result from something that disrupted the normal healing process the first time around - either the fracture itself, or factors affecting the body's ability to heal it.
- Inadequate immobilisation - a cast, splint, or fixation that allowed too much movement at the fracture site during healing.
- Poor blood supply - certain bones and fracture patterns naturally heal more slowly due to limited blood flow to the fracture site.
- Infection - bacteria at the fracture site can prevent normal bone healing.
- Smoking - nicotine significantly impairs bone healing and is one of the most modifiable risk factors for non-union.
- Underlying health conditions - diabetes, poor nutrition, and certain medications can slow or prevent healing.
- Severe soft tissue damage - fractures with significant surrounding tissue injury often have a higher non-union risk.
Signs and Symptoms
- Persistent pain at the fracture site, months after the original injury
- Visible deformity, shortening, or rotation of the limb
- A feeling of movement or instability at the old fracture site
- Swelling or tenderness that does not resolve
- Inability to bear weight or use the limb normally despite adequate healing time
Diagnosis
X-rays are the first step, comparing the fracture's current appearance against what would be expected at that stage of healing. A CT scan may be used to assess bone bridging in more detail, and blood tests or imaging may be used to check for underlying infection if an infected non-union is suspected.
Treatment Approach
Treatment depends on the specific cause. Malunion often requires a corrective osteotomy - deliberately re-breaking and realigning the bone - followed by fixation to hold the new position. Non-union frequently needs revision surgery with more stable fixation, sometimes combined with bone grafting to stimulate healing. Infected non-union requires treating the infection first, often alongside the bone repair itself. Dr. K. G. Gopalakrishna evaluates the specific pattern and underlying cause before recommending the right combination of treatment.
Please note: This page is for general information only and does not replace a proper medical evaluation. Every case is different, and the underlying cause of your symptoms may not match what is described here. Please do not use this page to self-diagnose - consult Dr. K. G. Gopalakrishna or another qualified orthopaedic specialist for an accurate diagnosis specific to you.
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Last reviewed: August 2026