Understanding the problem

Nonunion means that a fracture has failed to heal; delayed union means healing is taking longer than expected. Malunion means the bone has healed in an altered position, potentially affecting alignment, length or joint loading. Symptoms may include persistent pain, instability or a limp. Assessment uses your history, examination and serial X-rays, sometimes CT. Blood tests and, where appropriate, tissue samples help investigate infection or other contributors.

Treatment and the procedure

Treatment addresses both stability and the biology of healing. Options may include continued protection, selected bone-stimulation treatment or revision fixation with bone grafting. Infection can require tissue removal, antibiotics and staged reconstruction. A symptomatic malunion may need an osteotomy, in which the bone is cut and realigned, then stabilised with internal fixation or a frame. Not every malunion needs surgery. Complex bone loss or deformity may need specialist limb reconstruction.

Benefits, risks and expectations

If surgery is planned, discuss bleeding, anaesthetic risks and complex regional pain syndrome as well as the risks specific to your injury. Your general health and the extent of surgery affect your personal risk.

The aim is a healed, more stable and functional limb with improved alignment where necessary. Pain relief and full restoration of function cannot be guaranteed.
Discuss infection, bleeding, nerve or vessel injury, stiffness, blood clots, further nonunion, residual deformity and additional operations. Bone graft taken from your body introduces a separate harvest site with its own risks.
Treatment can be lengthy, particularly with infection or a frame. Multiple procedures and changes to the initial plan may be necessary.

Rehabilitation and aftercare

Follow written loading, exercise, wound and pin-site instructions. Do not adjust a frame unless the reconstruction team has specifically taught and prescribed the adjustment. Imaging and clinical review guide progression. Physiotherapy maintains permitted joint movement and builds function as healing allows. Discuss smoking cessation, nutrition, diabetes control and medication review with the team. Plan practical help and work adjustments, and raise difficulties early.

When to get urgent help

Seek urgent review for spreading redness, pus, fever, sudden new instability or worsening pain. A cold limb, new weakness or sudden severe pain needs A&E assessment.
New calf pain or swelling needs urgent advice. Call 999 for chest pain or breathlessness.

Your consultation

Ask whether infection is suspected, which goals reconstruction can achieve, whether graft or a frame is proposed and how many stages are anticipated. Personalised consent includes alternatives and the consequences of deferring treatment.

Your consent discussion

Use the patient pack to record your priorities, the proposed procedure, its alternatives, the benefits you hope for and risks that matter to you. A clinician will discuss your individual circumstances and complete the appropriate hospital consent process with you.

Reading or downloading a guide does not give consent. You can ask further questions, decline treatment or change your mind before the procedure.

Nonunion and malunion