Malunion of the hand and wrist

A malunion is a condition that occurs when a broken or fractured bone heals in an incorrect or misaligned position. This can lead to deformity, pain, and loss of function or mobility in the affected area. In the hand and wrist, malunions can significantly impact a person's ability to perform daily tasks and activities by limiting motion. The misalignment can also lead to excess wear and tear on the cartilage within nearby joints, which can cause painful arthritis.

One of the most common bones in the hand and wrist to experience malunion is the distal radius, which is one of the two long bones in the forearm. A distal radius malunion can result in a noticeable deformity and can cause significant pain and functional impairment. Malunions also can occur in other bones in the hand and wrist including the carpal bones, metacarpals, and phalanges.

Malunions can occur for a variety of reasons, including inadequate immobilization after the initial fracture, severe trauma, or complex fractures that are difficult to align properly. Understanding the causes and risks of malunion in the hand and wrist can help in early detection and treatment.

Malunions are often suspected if there is persistent pain, deformity, or loss of function in the hand or wrist following the healing of a fracture. The first step in diagnosing a malunion is typically an X-ray, which can help evaluate the alignment of the healed bone. However, additional imaging with CT or MRI scans may be necessary to better evaluate the malunion and plan for potential corrective surgery.

In some cases, a physical examination and functional tests may also be used to assess the impact of the malunion on the patient's ability to use their hand or wrist. The evaluation process is crucial in determining the best course of treatment for malunions in the hand and wrist.

Treatment for malunions in the hand and wrist can vary depending on the specific situation and the severity of the malunion. Non-operative treatments, such as physical therapy and splinting, may be sufficient for minor malunions that do not significantly impact function or cause pain.

However, in many cases, surgery is needed to correct a malunion. This typically involves a procedure known as an osteotomy, where the bone is cut and realigned in the correct position. Metal hardware, such as plates and screws, may be used to hold the bone in place while it heals.

In the case of a distal radius malunion, the surgeon may need to perform a corrective osteotomy to restore the normal alignment of the wrist. This can significantly improve function and reduce pain.

In recent years, virtual surgical planning (VSP) with 3D printed models has become an increasingly important tool in the treatment of malunions, particularly for complex malunions. This technology allows surgeons to create a detailed 3D model of the patient's bone structure using a high resolution CT scan, which can be used to plan the surgery in detail before it takes place. The 3D model can also be used intra-operatively as a cutting guide, helping to ensure that the bone is cut and realigned with a high degree of precision. This can improve the accuracy of the surgery, potentially leading to better outcomes for the patient.

Recovery after surgery for a malunion in the hand and wrist typically involves a period of immobilization, where the patient is required to wear a cast or splint to protect the surgical site and allow the bone to heal in the correct position. This is often followed by a course of physical therapy to restore strength and mobility in the hand and wrist.

The duration of the recovery period can vary depending on the specific procedure and the individual patient, but it may take several months for the bone to fully heal and for the patient to regain function of their hand or wrist. During this time, it is important for patients to follow the surgeon's post-operative instructions and to attend all follow-up appointments to ensure the best possible outcome.

Be sure to see an experienced surgeon to treat this condition. Our fellowship-trained specialists at The Buncke Clinic in San Francisco treat patients with malunions of the hand and wrist from across the Bay Area and Northern California. Contact us to schedule a consultation.