Corrective Osteotomy for Malunion

Indications

  • Symptomatic deformity affecting function or adjacent joints
  • Malalignment that predicts early arthritis
  • Malunion causing pain, instability or impingement
  • Rotational malalignment of forearm or femur affecting function
  • Leg length discrepancy combined with angulation

Position

  • Depends on site
  • Supine on a radiolucent table for lower limb osteotomies
  • Prepare the opposite limb for rotational comparison where needed
  • Image intensifier access to the whole bone

Operative Steps

  1. Measure deformity in coronal, sagittal and rotational planes and length
  2. Full length standing films, CT for rotation
  3. Find the centre of rotation of angulation (CORA, Paley)
  4. Cut at the CORA where possible, otherwise add translation
  5. Choose opening wedge, closing wedge, dome or single cut oblique osteotomy
  6. Graft opening wedges and fix rigidly
  7. Plan on templates or with 3D printed guides for complex multiplanar deformity
  8. Release contracted soft tissues before correction
  9. Gradual correction with a hexapod frame suits large or multiplanar deformity and lengthening
  10. Check alignment intraoperatively with the cautery cord or a long alignment rod

Postoperative Care

  • Protected loading until union
  • Radiographs at 2, 6 and 12 weeks
  • Full length standing films after union to confirm alignment
  • Early joint motion to limit stiffness

Complications

  • Under or over correction
  • Nonunion
  • Nerve stretch, peroneal nerve with tibial valgus correction
  • Compartment syndrome
  • Infection and wound breakdown
  • Loss of correction before union
  • Hardware irritation needing removal

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.