Malunions or limb deformity

For many kids, broken bones are a short and relatively simple detour on their childhood journey. But when a child’s fractured bone heals abnormally, it can lead to a limb deformity called a malunion.

About malunions or limb deformity in kids

Most childhood fractures heal well. But sometimes, a child’s bone fragments will shift and then heal when they aren’t perfectly lined up. Known as a malunion fracture, this complication can affect the appearance and function of your child’s limb. The bone might be shorter, twisted or bent. It most commonly occurs after fractures of the collarbone, elbow, wrist and hand, among other parts of the body. Malunions are more common after complex fractures, including:

• Comminuted fracture – when the bone shatters into multiple pieces
• Angulated fracture – when the bone breaks at an angle, like a broken tree twig
• Rotated fracture – when the bone fragments rotate out of position so that the two ends don’t line up neatly

Experts in malunions or limb deformity

As the only comprehensive pediatric hand and upper extremity program in the state, Children’s Wisconsin provides expert care to kids and teens with a wide range of common and rare conditions affecting the shoulder, arm, elbow, wrist and hand. With our team’s specialized training, vast experience and deep knowledge of the unique challenges of children’s growing bodies, we can ensure the best possible outcomes for your child’s recovery after a malunion fracture or limb deformity. Our child-centered environment and wraparound services are designed to support the whole family and provide comfort when your child is stressed and in pain. If your child has already been diagnosed at another center, we invite you to get a second opinion at Children’s Wisconsin.

What causes malunions or limb deformity in the hand and upper extremity?

Several factors can cause this complication: a delay in treatment might cause the bone to start healing abnormally before it’s properly aligned, the bones might shift out of place after being set or the pattern of fracture might make it more difficult to heal correctly. A fracture that injures a child’s growth plate can also cause limb deformity.

Why are malunions or limb deformity a concern?

More mild cases of malunion might not cause a child any problems. But if left untreated, many malunions can cause pain, impair a child’s normal functioning in daily activities and cause long-term problems, such as arthritis in nearby joints.

What are the symptoms of malunions or limb deformity?

Signs of a malunion may include:

• Pain or tenderness at the fracture site
• Pain in nearby joints
• Swelling
• Visible deformity (appears different from the opposite limb)
• Difficulty with limb movement or function

How are malunions or limb deformity diagnosed?

The physician will evaluate your child’s injury through a physical examination and imaging. At Children’s Wisconsin, we use imaging procedures that ensure your child is exposed to the smallest amount of radiation possible. Imaging procedures may include:

X-rays – Uses invisible electromagnetic energy beams to produce images of internal tissues, bones and organs onto film

Magnetic resonance imaging (MRI) – Uses a combination of large magnets, radio frequencies and a computer to produce detailed images of organs and structures within the body

Computed tomography scan (CT scan) – Uses a combination of X-rays and computer technology to produce detailed, cross-sectional images of the body, including the bones, muscles, fat and organs

Treatment for hand and upper extremity malunions or limb deformity

Treatment will vary depending on the type and severity of your child’s malunion. Your child’s treatment plan may include:

Surgical repair – A procedure called an osteotomy involves cutting the bone to realign it. The surgeon might use screws, wires or metal plates to hold the bone fragments in place. If the bone is shortened, the doctor might recommend a limb-lengthening procedure. Our highly skilled pediatric orthopedic surgeon will surgically repair the bones, tendons and soft tissue in a precise and delicate manner to preserve your child’s movement and function in the future.

Sling/splint/cast – Once your child’s bone has been repositioned in the right place, they will need to wear a sling, splint or cast (depending on the area injured) to immobilize and protect the area so the bone can re-heal.

Medical management – Anti-inflammatory medications can relieve a child’s pain immediately after the injury and as they recover.

Hand therapy – Hand therapy is a critical part of the postsurgical and nonsurgical process to promote healing, increase range of motion and maximize functional use of your child’s hand/arm. Our certified hand therapist offers serial casting, custom splinting, paraffin wax treatments, scar massage and more.

Rest – Your child will need to take a break from athletics or other activities that worsen their discomfort until they heal.

Long-term outlook for malunions or limb deformity

With proper treatment by a pediatric expert, most childhood malunions can be corrected and heal well. Depending on the severity of the malunion, some children might have issues with strength, range of motion or function, which can be improved with physical therapy. Some malunions can cause long-term joint problems, such as post-traumatic arthritis or joint instability. Your child will need to continue to be monitored for complications as they grow.