Page 181 - ASOP ROT Study Guide

10.8 Mal-union
Mal-union implies that the fracture has been allowed to heal in a position that precludes
normal function. It usually implies failure of the treatment method, or neglect by a
surgeon, or by non-attendance at out-patient clinics. Regular out-patient review is the
mainstay of fracture management and regular radiological and clinical examinations are
essential to ensure all is going well. Once recognized, mal-union may be treated by open
reduction and internal fixation.
10.9 Growth Arrest
If a fracture breaches the germinal layer of the epiphyseal growth plate (Skeletal Anatomy
and Physiology Unit 2), bone growth may be arrested at the point of breach, resulting in
deformity. These are rare injuries and difficult to manage. Children have a great
capacity to remodel mal-united fractures, although they will not remodel rotary
deformities.

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10.10 Arthritis
Arthritis will develop secondary to a fracture if a joint is excessively stressed. This will be
likely if a fracture goes across a joint and disturbs the surfaces so that the joint is no longer
congruent (i.e.. the two surfaces are no longer parallel). A very angulated fracture will
also stress a joint by putting uneven forces on it. Occasionally, direct damage to the
articular cartilage will result in arthritis. Good fracture management should minimize, but
will never totally exclude, the risk of developing arthritis.