Malunions & Non-unions of Fractures

Surgical reconstruction for fractures that have resulted in malunion, i.e., angulations of the bone, and/or non-union, i.e., non-healing of the bone involve fracture fixation as well as bone grafting. In distal radius fractures which have healed MAL-angulation, an osteotomy, i.e., re-breaking of the bone, and placement of appropriate hardware such a plate and bone grafting are indicated to realign the radius in a better position. This is important in an effort to prevent further degenerative changes at the mid carpal or radial carpal joints and at the distal radial and ulna joint. Postoperative treatment includes bracing and early immobilization of the wrist and fingers. Non-unions in the wrist bones are most commonly seen at the level of the scaphoid. This most commonly occurs when a fracture is not appreciated at the initial time of evaluation and/or is neglected by the patient.

Treatment includes that of screw fixation and bone grafting which can either be non-vascularized and or vascularized based pedicle. Studies have shown that there is no significant difference in healing between the two graft types. In addition, there is an approximately 85 to 90% chance that a non-union of the scaphoid will heal with fixation and bone grafting. In addition to this technique, the healing process is supplemented by the use of a bone stimulator after the surgical procedure in an effort to promote healing. Studies again have shown that this helps to increase the chance of healing as well decrease the time to heal the scaphoid non-union.