A fracture heals with angulation and rotation deformity, but the fracture ends are united with bridging callus. Which complication of fracture healing is this?

Explanation

## Malunion: Fracture Healing in Abnormal Position ### Definition **Malunion** is healing of a fracture in an anatomically incorrect position or alignment, with bridging of the fracture ends by callus, but with resultant deformity. ### Key Characteristics **Key Point:** Malunion = **Union occurs** (callus bridges the gap) **BUT in wrong position** (angulation, rotation, shortening, or displacement). **High-Yield:** The hallmark of malunion is the presence of: - Bridging callus (fracture has united) - Visible deformity (angulation, rotation, shortening) - Loss of anatomical alignment - Potential functional impairment ### Pathophysiology 1. Fracture ends heal and unite with callus formation 2. Healing occurs in the position the fragments were left (often displaced or angulated) 3. Callus hardens and consolidates in this abnormal position 4. Result: Bony union achieved, but with deformity ### Classification of Malunion Deformities | Type | Description | Clinical Impact | |------|-------------|----------------| | **Angulation** | Fracture heals at an angle | Cosmetic deformity, joint stress | | **Rotation** | Fragments rotate relative to each other | Functional impairment, gait disturbance | | **Shortening** | Loss of bone length | Limb length discrepancy, gait abnormality | | **Displacement** | Lateral or medial shift of fragments | Mechanical axis deviation | ### Distinction from Other Healing Complications | Complication | Union Status | Callus Present | Deformity | Bridging | |-------------|-------------|----------------|-----------|----------| | **Malunion** | YES | YES | YES | YES | | **Non-union** | NO | Minimal/absent | Variable | NO | | **Delayed union** | YES (slow) | YES | Usually NO | YES (delayed) | | **Pseudarthrosis** | NO | Minimal | Variable | NO | ### Clinical Pearl **Clinical Pearl:** Malunion is often **preventable** through proper reduction and maintenance of alignment during the healing phase. Early recognition and correction (before callus consolidates) may allow re-manipulation or surgical correction. **Warning:** Do not confuse malunion with non-union — in malunion, the fracture **has united**; in non-union, it **has not**. ### Management Implications - **Mild deformity:** Observation if functionally acceptable - **Significant deformity:** Osteotomy or re-fracture and re-reduction may be needed - **Prevention:** Accurate reduction and maintenance of alignment during healing