What are non-union and malunion?

After bone trauma, problems with bone healing and alignment can occur. Two problems are common for bone injuries – non-union and malunion. Non-union is when the bone doesn't heal properly leaving pain and instability in the limb. Malunion is when the bone heals, but it heals in an ill position or shortened position. In these cases, reconstructive orthopaedic surgeries such as an oestonomy, joint replacement, ligament repair and arthroplasty are needed to repair it to restore functioning and mobility.

What does treatment involve?

While non-surgical means of treatment may involve electric stimulation or bracing (for non-union), reconstruction of bones that have non-union or malunion often involves surgery or a combination of both. Reconstruction of non-union is done to restore damaged bone and tissue and stabilise the bone. This is usually done with the use of bone grafts to stimulate bone healing. To restore the bone and surrounding tissue, the gaps are filled with bone grafts from another part of the body. These fresh bone cells act as a scaffold to stimulate the fusion of the bone. This fusion may take time, and thus an internal or external fixation may be needed to give stabilisation in the meanwhile. Internal fixation is a metal plate which is attached to the outside of the bone with nails. An external fixation, however, is a rigid frame which is attached to the outside of the fracture site through wires or pins that are connected internally to the bone.

A surgery called an osteotomy might be considered to realign, shorten or lengthen the bones that may have a malunion. This may require the bone to be re-broken to align. After the deformity has been corrected, internal or external fixation may be needed to ensure the bone heals correctly.

What can I expect in terms of recovery?

Recovery will depend on the severity of malunion or non-union. You may also expect an internal fixation or external fixation on the limb after surgery. Dr Heymans will decide on the best method and inform you of what you can expect for recovery. Pain and swelling of the area are common, and you may need to use a sling, brace or crutches depending on the area on which kind of surgery was done. After a few weeks, you will be advised to do exercises with the help of a physiotherapist to strengthen, coordinate and get the full range of motion of the limb. How long it will take before you are back to normal will depend on the surgery done, and Dr Heymans will be able to give you more information on this.