Malunion Fractures

After a bone is broken (fractured), the body will start the healing process. If the two ends of the broken bone are not lined up properly, the bone can heal with a deformity called a malunion. A malunion fracture occurs when a large space between the displaced ends of the bone have been filled in by new bone. 

With fractures in the hand, wrist and forearm, a certain amount of angulation, or bend, occurs when the bone heals. Doctors determine if the position of a fracture will allow for functional use of the hand or arm after it heals. In many cases, when a fracture heals in a position that interferes with the use of the involved limb, surgery can be performed to correct it. 

Some examples of common upper extremity fractures that may result in malunion include fractures of the wrists (distal radius), hand bones (metacarpals), and fingers or thumbs (phalanges).

If you fractured a finger, hand, wrist or elbow, and it has healed but no longer functions well, you should seek an opinion from a doctor who knows the upper extremity of the body well.

For decades the University of Michigan Department of Orthopaedic Surgery -- one of the oldest and most well-regarded orthopaedic units in the nation -- has provided excellent treatment for malunion fractures. 

Our goal is to restore you to pre-fracture function as much as possible, as well as improve your long-term bone health. We are also part of the American Orthopaedic Association's Own the Bone Program to improve the care of fracture patients age 50 and up.

In addition, the University of Michigan is a Level 1 Trauma Center, which means you will receive the highest level of care by experts who regularly treat patients with complex fractures and multiple bone breaks.


These symptoms usually occur after the healing of the initial fracture/break:

  • Angulation (bend) and/or rotation of the fractured bone.
  • A wrist that does not flex or extend to allow normal use.
  • A finger that “scissors” onto or away from an adjacent finger.
  • Altered use or function of the involved limb.
  • Stiffness in finger, hand, wrist or elbow.


  • History and physical exam: Your doctor or mid-level health care provider will obtain a history of your problem and perform an appropriate physical exam to find the exact area of concern.
  • Imaging: Usually, imaging of the site in question begins with X-rays. If more information is needed, your doctor or mid-level provider may order a CT Scan or an MRI.
  • Surgery: The goal of treatment is to realign your bone in a position that improves the function of the upper extremity. While you are under anesthesia in the operating room, your surgeon will re-break the bone to realign the fracture. Depending on the type of malunion, some of the bone may need to be trimmed to allow for proper orientation of the fractured ends. To keep the straightened bone in proper alignment, your surgeon may insert screws, plates, and/or pins. Additionally, the surgeon may perform a bone graft to aid in fracture healing.

Pre-operative Care

If a decision for surgery is made after seeing one of our Orthopaedic Hand Surgeons, you may require pre-operative medical clearance by our Anesthesia department or your Primary Care Provider. This depends on your other chronic medical conditions. Your surgeon will let you know if this clearance is necessary. 

Post-operative Care

Your physician will give you specific instructions. In general:

  • After surgery, you will be placed in a post-operative dressing/splint which you must wear until your first post-operative visit with one of our providers. You must keep the dressing CLEAN and DRY to avoid risk of infection and other wound healing complications.
  • Someone should be with you for the first 24 hours after surgery.
  • You will be given a prescription for post-operative pain medicine. Do not take it with other pain medicines unless directed by your doctor. Do not drive, drink alcohol or make important decisions while taking the pain medicine.
  • Do not smoke, use smokeless tobacco, nicotine gum or nicotine patches. Nicotine is a vasoconstrictor, and can impede healing by limiting blood flow to the surgical site(s).
  • You must remain non-weight bearing (no use) with the surgical hand and arm until cleared by one of our health care providers. This may be several weeks, depending on your healing.
  • At the first post-operative visit, your stitches will be removed. You will be placed in either a cast or a splint, depending on your surgeon’s preference. If your cast becomes wet or soiled, you should come into the office for a new cast as soon as possible.
  • To evaluate the healing of the fracture at your follow-up appointments, your doctor will order imaging such as X-rays or a CT scan.
  • After several weeks of immobilization, you will probably be stiff and weak in your hand / wrist. We often send patients to an Occupational Therapist with the goal of regaining functional use of the operative hand. Remember: You are an active participant in your care, and part of your recovery depends on your desire to participate in occupational therapy.

Contact Us / Make an Appointment

  • Orthopaedics, 734-936-5780

Selecting a health care provider is a very important decision. Because we are highly experienced in treating malunion fractures and all conditions of the musculoskeletal system, we would like to help you explore your options. Visit our Contact Us page to see a list of clinics and their contact information. Our staff will be glad to talk with you about how we can help.