What is a Mal-Union of a Fracture and How is it Treated?

When the body sustains an injury like a broken bone, the body will immediately start the healing process of mending the bone. However, sometimes the two ends of the fractured bone won’t line up appropriately, but still heal, creating what is called a Mal-Union.

For areas of the body, like the hand or wrist, there can be a certain amount of asymmetry that can be tolerated and won’t negatively impact function. However, in many cases, the mal-union of a fracture can reduce function in daily activities and need the help of an orthopedic reconstruction specialist to help the fracture heal.

As an orthopedic surgeon in Los Angeles specializing in complex orthopedic conditions and complications, Daniel C. Allison, MD, FACS has a unique skill set perfect for successfully treating patients with Mal-Unions of fractures. From diagnosis to treatment, complex conditions like Mal-Unions require advanced training and technique to repair and restore function. Let’s explore what is a Mal-Union fracture and now they’re treated.

What is a Mal-Union Fracture?

Mal-union fractures have unique symptoms, primarily the appearance of a bend in the previously broken bone. Other symptoms can include:

  • Deformity
  • Pain
  • Swelling
  • Instability
  • Reduced function in typical activities
  • Decreased range of motion
  • Intolerance for weight-bearing activities
  • Limp

What Causes a Mal-Union Fracture?

Most mal-unions are caused by inadequate mobilization or misalignment during treatment. Mal-unions can also occur if a fracture has been displaced and not treated. This leads to deformity of the bone or joint, decreased limb function, and potential joint degeneration issues like arthritis or instability at the joint.

Mal-unions occur when the bone fragments join in an unsatisfactory position. 5-10% of all fractures annually end up in mal-union. This can lead to pain and reduced ability to perform daily tasks.

For example, mal-unions can occur in the lower extremities such as the ankle, foot, or toes. When a patient sustains a fracture in one of these areas and a mal-union is created, they may experience chronic tenderness and difficulty performing tasks like walking, running or prolonged standing.

There are several factors that can lead to a patient developing a mal-union fracture. These factors include:

  • Severe soft tissue damage
  • Inadequate blood supply to the injury
  • Infection
  • Insufficient and/or misaligned splinting
  • Inadequate immobilization
  • Excessive traction
  • Aging
  • Anemia
  • Diabetes
  • Low vitamin D level
  • Hypothyroidism
  • Certain medications including NSAIDs and steroids.
  • Complex/compound fracture
  • Osteoporosis or osteopenia

Treatment for a Mal-Union Fracture

Not all mal-unions require additional treatment. When a patient suspects they have sustained a mal-union of a fracture, it is vital that they get in touch with an experienced orthopedic surgeon for an accurate diagnosis and if necessary, treatment.

If a mal-union doesn’t negatively impact function in daily activities or mobility, there is a good chance it won’t need to be reset. However, when a patient is experiencing chronic pain or a loss in range of motion and functional movement, surgical repair may be needed to help restore the bone’s alignment. Learn more about treatment for Mal-union fracture, please visit ncbi.gov.

Ball and Socket Orthopedic Surgery LAWhat Does Surgery for a Mal-Union Fracture Entail?

Most mal-unions require surgery where your orthopedic surgeon will cut a portion of the bone, also known as an “osteotomy. This needs to be performed in the area of the break in order to allow the doctor to reset it.

An osteotomy is typically performed using the traditional “open” method versus a minimally invasive procedure. At the time of surgery, any infected bone or tissue is removed and treated with antibiotics to avoid osteomyelitis (bone infection). The limb is then realigned and stabilized using an internal fixation device, which could be a rod, screw or metal plate.

To have the best result with surgery of this kind requires a surgeon who has the skill and expertise treating these types of fractures and performing reconstructive surgery to restore function. Dr. Allison has dedicated his practice towards treating patients with complicated orthopedic injuries and helping them achieve a successful outcome.


If you have experienced a fracture and are concerned with its healing or are experiencing pain, contact Dr. Daniel C. Allison in Los Angeles today to schedule a consultation for a precise diagnosis and treatment. Experts in complex fractures and bone trauma, Dr. Allison and his team will utilize the least invasive, but most effective treatments available to help your fracture heal and return you to pain-free function.

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