Malunion Surgery of the Shoulder

What is Malunion Surgery of the Shoulder?

Malunion, also known as crooked healing, is the failure of a fractured bone to rejoin properly due to poor alignment of the fracture fragments. The condition results in abnormality and deformity of the bone (bent or twisted bone).

Malunion surgery of the shoulder is a surgical procedure employed for the treatment of shoulder malunion. A shoulder malunion is a condition where the fractured ends of a proximal humerus bone heal in a misaligned position resulting in bone deformity. An Orthopaedic surgery called an osteotomy is most often employed to restore proper alignment of the bone that has not healed properly.

Osteotomy is a surgical procedure to cut and reshape deformed bones. Your surgeon recommends an osteotomy to correct bone malunion when non-surgical treatment options such as splinting or physical therapy have not been successful.

Shoulder Anatomy

The shoulder is a highly movable body joint that allows various movements of the arm. It is a ball and socket joint, where the head of the humerus (upper arm bone) articulates with the socket of the scapula (shoulder blade), which is called the glenoid. The two articulating surfaces of the bones are covered with cartilage, which prevents friction between the moving bones. The cartilage is lubricated by synovial fluid. Tendons and ligaments around the shoulder joint provide strength and stability to the joint.

Indications for Malunion Surgery of the Shoulder

Malunion surgery of the shoulder is recommended for the treatment of:

• Deformity of the shoulder bone (twisted, bent, rotated, or shortened bone)
• Stiffness and difficulty flexing or extending the shoulder
• Pain, swelling, discomfort, and tenderness in the shoulder
• Restricted range of motion and functioning of the shoulder joint

Preparation for Malunion Surgery of the Shoulder

Preoperative preparation for malunion surgery of the shoulder will involve the following steps:

• A thorough examination by your doctor is performed to check for any medical issues that need to be addressed prior to surgery.
• Depending on your medical history, social history, and age, you may need to undergo tests such as blood work and imaging to help detect any abnormalities that could threaten the safety of the procedure.
• You will be asked if you have allergies to medications, anaesthesia, or latex.
• You should inform your doctor of any medications, vitamins, or supplements that you are taking.
• You should refrain from medications or supplements such as blood thinners, aspirin, or anti-inflammatory medicines for 1 to 2 weeks prior to surgery.
• You should not consume any solids or liquids at least 8 hours prior to surgery.
• Arrange for someone to drive you home after surgery.
• A written consent will be obtained from you after the surgical procedure has been explained in detail.

Procedure for Malunion Surgery of the Shoulder

To correct shoulder malunion, your doctor may perform a bone realignment osteotomy (correction osteotomy) and placement of bone graft. Osteotomy, an Orthopaedic surgical procedure, is commonly used to realign the bones in the correct position. The procedure may involve shortening or lengthening before the realignment. The aim of treatment is to correct the proximal humerus bone deformity and improve shoulder function.

The procedure may be performed under regional or general anaesthesia, and in general, involves the following common steps:

• An incision is made at the proximal humerus around the shoulder joint.
• The area of deformity is exposed. Care is taken to prevent damage to the nerves.
• The proximal humerus bone is re-broken and the fracture fragments are realigned properly.
• The bone may be trimmed or reshaped for proper orientation if necessary.
• Screws, pins, or plates may be used to stabilise the fracture union as it heals.
• Bone graft may be placed at the site to promote bone growth and fusion.
• The incision is closed with sutures and covered with a sterile bandage.

Postoperative Care and Instructions

In general, postoperative care instructions and recovery after malunion surgery will involve the following steps:

• You will be transferred to the recovery area where your nurse will closely observe you for any allergic/anaesthetic reactions and monitor your vital signs as you recover.
• You may need to stay in the hospital for 2 to 3 days before discharge to home.
• You may notice some pain, swelling, and discomfort in the shoulder area. Pain and anti-inflammatory medications are provided as needed.
• Your arm may be secured with assistive devices such as a sling or a cast for the first few weeks to facilitate healing with instructions on restricted weight-bearing.
• Keep the surgical site clean and dry. Instructions on surgical site care and bathing will be provided.
• Refrain from smoking as it can negatively affect the healing process.
• Refrain from strenuous activities for the first few months and lifting heavy weights for at least 6 months. Gradual increase in activities over a period of time is recommended.
• An individualised physical therapy protocol will be designed to help strengthen shoulder muscles and optimise shoulder function.
• Most patients are able to resume their normal activities in a month or two after surgery; however, return to sports may take at least 6 months or longer.
• Refrain from driving until you are fully fit and receive your doctor’s consent.
• A periodic follow-up appointment will be scheduled to monitor your progress.

Risks and Complications

Malunion surgery of the shoulder is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as the following:  

• Infection
• Bleeding
• Postoperative pain
• Damage to nerves and vessels
• Instability
• Thromboembolism or blood clots
• Anaesthetic reactions