Radius fracture malunion

What is a radius fracture malunion?

Radius fractures belong to the most common bone fractures in humans. In the majority of cases, the radial bone (radius) breaks in the region of the forearm furthest from the body, more rarely in the middle region or near the elbow. Like any fracture, it is possible for bone fragments to fail to align correctly after healing, resulting in malunion. 

Along with the ulna, the radius forms the forearm. Moreover, the radius, together with the carpal bones, forms the wrist joint and, alongside the humerus and ulna, the elbow joint. Due to its complex and diverse function, a mishealed radius fracture can cause functional impairment of the entire forearm, including the elbow and wrist.

Some of the many complications that may develop when a radius fracture heals are particularly common. They include nerve damage, deformities and the premature onset of osteoarthritis which refers to wear and tear of the joints as joint cartilage wears off.

Osteoarthritis comes naturally with age. However, it may be seen earlier and to a greater extent as a result of incorrect strain after a poorly healed fracture.  

How do fractures of the radius heal incorrectly?

There are many factors that can cause a radius fracture to heal incorrectly. It is important to differentiate between fracture-related factors and those that are due to the treatment of the fracture.

Some fractures have an increased complication rate despite proper treatment. Among these are very complicated fractures with multiple fragments (comminuted fractures) or severe misalignment of the fragments. The likelihood of fractures healing in a malposition is particularly high in this case.

Choosing the wrong treatment in the primary course of treatment represents another important reason for mishealed radius fractures.

As various treatment options are available for radial fractures, the chosen one is not always the best. The difficulty is that fractures do not always heal in the same way and the effectiveness of a particular treatment method often only becomes clear after a few weeks.  

Potential complications can arise, for example, if the selected treatment does not stabilize the fracture sufficiently or if the fracture fragments are not correctly aligned. During the healing process, the body can correct such misalignments only to a small extent, and the result is secondary damage.

Which symptoms occur frequently?

Depending on the type of fracture and how badly it has healed, the symptoms can vary in severity. Patients generally describe pain, limited mobility and loss of strength.  

These symptoms are a result of the complex function of the radius bone. Since the bone is responsible for many different movements of the forearm, a deformity can affect the function of several joints. Moving the respective joint is usually perceived as painful. 

Since the radius usually breaks close to the wrist, the symptoms occur particularly frequently in this area. This is because the radius may be rendered a little shorter after the fracture, which means that the ulna is too long relative to the radius. As a result, the carpal bones place increased pressure on the ulna, leading to so-called ulnar impaction syndrome.  

How is malunion of a radius fracture diagnosed?

Diagnosing a mishealed radial fracture always starts with a detailed medical history. It is particularly important to gather detailed information about the original fracture of the radius and the current symptoms. Previous x-ray scans and other results are also reviewed at this stage.

This is followed by a physical examination during which the entire forearm is examined and the range of movement of the joints are precisely recorded. Different clinical tests are carried out to check the individual functions of the radius and the joints.

Diagnostic imaging procedures also provide important diagnostic information. An X-ray examination of the affected area is the first step, although further imaging procedures like MRI or CT scans may also be needed depending on the findings. It is always helpful to compare the affected arm with the healthy opposite side to assess the extent of the healing defect.  

What treatment options are available?

• Conservative therapy 

Depending on the degree of deformity and the symptoms, either conservative or surgical options should be considered. Conservative measures are available either independently or in combination with surgery. 

The basis of conservative therapy for mishealed radius fractures is physiotherapy. The main aim here is to improve wrist mobility by specifically exercising the individual muscles, ligaments and joints. Patients usually find it hard to turn their wrist, so this is a particular focus. 

Adding to physiotherapy, ergotherapy can also help to use the forearm in daily life after a mishealed radius fracture. Different bandages or braces can also provide relief for those affected.

If the conservative measures fail to improve the symptoms enough, surgery should be considered.

• Surgical therapy: corrective osteotomy 

In the majority of cases, surgery is the preferred method of treatment for malunion of radius fractures. The most common method is a so-called corrective osteotomy.

Osteotomy is a procedure in which a bone is cut in a specific way. The goal of a corrective osteotomy is to correct the deformity and restore the adequate anatomical position.

After the bone has been cut, its ends are first repositioned correctly in relation to each other. To fill the gap created between the bone fragments, a bone wedge is often fitted and secured with a wire. Such a bone wedge usually stems from the iliac crest, but it can also be harvested directly from the radius. Afterwards, the bone is secured with a plate.

This can be done to correct axis misalignments, such as rotations or inclinations of the radius, but also to compensate for shortening.

Corrective surgery should be performed before major damage has set in, for example before early osteoarthritis has developed.

Follow-up care & physiotherapy

As is the case after every operation, corrective osteotomy is followed by close monitoring and aftercare. Initially, this includes regular wound control and removal of the suture material after around 10 to 14 days. The implanted plate does not usually need to be removed.

The lower arm should always be trained as part of physiotherapy. Here it is important to begin as early as possible to maximize the range of motion. During the first few weeks after the operation, lymphatic drainage massage can also be provided to reduce swelling more quickly.

The foundation of any follow-up care is always a regular medical check-up, during which the results of the operation can be assessed. This is the only way to ensure a good treatment result.

Which doctors and clinics specialize in corrective osteotomy of the radius?

A malunion of a radius fracture can have a severe impact on the patient's everyday life. This makes appropriate treatment after a detailed diagnosis so important. However, patients often struggle to find and choose a competent doctor.

Our goal is to help bring patients and specialists together so that you can receive the best possible care for your individual symptoms. All of the hand surgeons listed here are experts in their field and have vast experience in the treatment of mishealed radius fractures. They are looking forward to your request for treatment.

Sources: 

• „Handchirurgie“, Towfigh/ Hierner/ Langer/ Friedel, Springer-Verlag, 2. Auflage, 2011.

•  „Operative Korrektur der in Fehlstellung verheilten distalen Radiusfraktur“, Baas, N., veröffentlicht in „Trauma und Berufskrankheiten“, 6. November 2013.

• „Orthopädie und Unfallchirurgie“, Joachim Grifka, 10. Auflage, Springer-Verlag, 2021.