For most of our patients who have sustained a fracture, the injury usually heals with the help of splinting or the use of a cast. However, there are times when the fracture improperly heals leading to what is called a Mal-Union fracture. Left untreated, mal-union fractures can lead to chronic pain, loss of range of motion and impairment in functioning during their day to day activities and work tasks. In rehabilitation, fractures that have not healed properly within six months after the initial date of injury are considered mal-union.

There are patients who have a mal-union fracture where it doesn’t interfere with their ability to complete daily tasks or result in a lack of mobility. For these patients: surgical intervention or rehabilitation are not necessary. However, for patients where the bone has been significantly impaired-- surgical intervention is needed and post-surgical rehabilitation is required to restore full pain-free function.

Identifying a Mal-Union Fracture

Once a bone is fractured, the body immediately begins the healing process and attempts to mend the bone. However, if the two ends of broken bone aren’t lined up symmetrically it leads to what is called a mal-union fracture. Patients who have a mal-union fracture have their own unique symptoms. One of the telltale signs of a mal-union fracture is that the limb will appear to bend at the site of the broken bone. Beyond this visual symptom, patients with a mal-union fracture may also experience:

• Chronic tenderness and pain
• Chronic edema
• Instability at the joint
• Difficulty performing day-to-day activities or job tasks
• Reduced range of motion
• Inability for weight-bearing activities or prolonged standing
• Gait issues like foot drop or limping

Treating a mal-union union fracture usually requires an osteotomy, which is a surgical procedure that requires a portion of the bone to be cut near the original fracture in order to correct alignment. This is done so that the bone can be correctly reset. Afterwards, the bone is correctly aligned and stabilized using either a rod, screw or metal plate. Healing from this type of procedure can take up to six months following surgery depending on the complexity and severity of the mal-union fracture. After surgery, physical therapy is necessary in order to help these patients reduce pain and increase functionality in daily tasks, strength and mobility.

Post-Surgical Mal-Union Fracture Case Study

A 33-year-old mother of two sustained a wrist fracture after a fall in her kitchen. After wearing a cast for six weeks, a subsequent x-ray showed that the bone had not healed optimally creating a malunion that causes pain during everyday tasks like bottle feeding her son and a decrease in range of motion with activities like yoga. With some fractures to the wrist, a certain amount of asymmetry can be tolerated, however in this case it was determined that the fracture did not allow for functional use of the hand or arm and created debilitating pain. After surgical intervention patient began physical therapy with the hopes of decreasing post-surgical pain and edema while at the same time hastening recovery and restoring function.

From start to finish there are several tools and modalities that were used to accomplish these goals, including:

1. Hand Evaluation Kit: As part of the initial evaluation, it makes sense to utilize a hand evaluation kit like the 3- piece digital Jamar hand evaluation set because this will help the practitioner establish a baseline of grip strength, pinch strength and range of motion. In addition, these test results can be used to identify areas of weakness or dysfunction. Further, a hand evaluation kit is useful to use periodically to evaluate gains and/or make adjustments as necessary to meet therapeutic goals. It is recommended to use an evaluation kit that includes.
   
   
2. Dynamometer: A hand dynamometer is used for establishing grip strength and identifying trauma after an injury.
3. Pinch gauge: A pinch gauge offers accurate readings of pinch strength (tip, key and palmer).
4. Goniometer: A goniometer is a range of motion readings for the finger joints.
5. Hand and wrist compression wrap: The hand and wrist compression wrap made by Game Ready is a useful tool for practitioners to use to provide patients with both cold therapy and compression. Both cold and compression are useful to address any pain and swelling post-surgical mal-union fracture patients might experience.
   
   
6. Paraffin therapy: Paraffin therapy is a great modality for practitioners to provide patients with effective heat therapy. A study published in the Pakistan Journal of Medical Sciencesfound that paraffin therapy when combined with joint mobilization was more beneficial in improving range of motion and reducing pain compared to joint mobilization used on its own. Paraffin therapy is a great modality to use throughout treatment to address any pain that may arise as a result of treatment or at the beginning of treatment to improve range of motion before any therapeutic exercise or stretching.
   
   
7. Ultrasound therapy: Ultrasound therapy is a trusted modality for physical therapist to use to help reduce pain and improve range of motion in the wrists. A case series published in the Journal of Athletic Trainingultrasound therapy when combined with joint mobilization helped patients achieve a normal range of motion after an injury. Further, the findings showed that patients who received ultrasound therapy and joint mobilization were able to return to their normal activities with up to 90% of participants maintaining a normal range of motion a month after end of treatment.
   
   
8. Functional Exercise: In addition to reducing pain and swelling a practitioner is committed to restoring function for postsurgical mal-union patients. One of the best modalities to achieve this is through functional exercise using therapeutic equipment like the Cando Magneciser Table Top Exerciser. The Magneciser table top exerciser helps improve a patient’s circulation, muscle strength and range of motion in a way that is safe and noninvasive.

When a patient sustains any type of fracture there is immediate concern for returning full-strength capability in performing everyday tasks. For our patients who sustain a mal-union fracture this concern greatly increases. However, with the help of advanced surgical intervention and appropriate post-surgical therapy it is possible for mal-union patients to return to full pain-free function.

Contact Us Today

We can help find the right therapeutic device or equipment to meet your post-surgical mal-union fracture patient’s needs. Contact us today and we’ll gladly help you find exactly what you need to achieve the best long-term outcomes for your patients. Call us today at 1-801-770-3328.