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Malunion
Malunion
Malunion
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Malunion
SpecialtyOrthopedics

A malunion is when a fractured bone does not heal properly. Some ways that it shows is by having the bone being twisted, shorter, or bent. Malunions can occur by having the bones improperly aligned when immobilized, having the cast taken off too early, or never seeking medical treatment after the break.[1] Malunions are painful and commonly produce swelling around the area, possible immobilization, and deterioration of the bone and tissue.[2]

Signs and symptoms

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Malunions are presented by excessive swelling, twisting, bending, and possibly shortening of the bone.[3] Patients may have trouble placing weight on or near the malunion.[4]

Diagnosis

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An X-ray is essential for the proper diagnosis of a malunion. The doctor will look into the patient’s history and the treatment process for the bone fracture. Oftentimes a CT scan and probably an MRI are also used in diagnosis. MRI are used to check of cartilage and ligament issues that developed due to the malunion and misalignment. CT scans are used to locate normal or abnormal structures within the body and to help during procedures to guide the placement of instruments and/or treatments.[3][5][6]

Treatment

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Once diagnosed and located, surgery is the most common treatment for a malunion. The surgery consists of the surgeon re-breaking the bone and realigning it to the anatomically correct position. There are different types and levels of severity for malunions which helps determine the treatment. Most often, either screws, plates or pins are used to secure the new alignment. In some cases, the bone may be trimmed to allow full orientation at the fractured spot. It is also possible that a bone graft could be used to help with healing.[citation needed]

During follow ups an X-ray or a CT scan may be used to verify that the fracture is healing properly and is now in the anatomically correct position.[citation needed]

See also

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References

[edit]
Revisions and contributorsEdit on WikipediaRead on Wikipedia

Malunion

View on Grokipedia
from Grokipedia
Malunion is a complication of in which the broken fragments unite in an abnormal or misaligned position, leading to potential , , or functional impairment of the affected limb or joint. This differs from , where the fails to heal entirely, typically after 6 to 9 months. Malunion occurs in a small but notable of fractures, with rates varying from 1% to over 30% depending on the type, and treatment method; it is more common in the lower extremities, such as the or . Symptoms may include , , and altered function, often requiring conservative or surgical correction to restore alignment and mobility.

Definition and Epidemiology

Definition

Malunion refers to the healing of a fractured in an anatomically incorrect position, leading to , shortening, rotational abnormality, or other misalignment that impairs function. This condition arises when the bone fragments unite despite suboptimal alignment during the repair process, resulting in a stable but malformed structure that may cause , limited mobility, or secondary issues like joint stress. Unlike , which involves a complete failure of the to heal and results in a persistent gap without bridging, malunion specifically denotes successful bony union albeit in a faulty orientation. Delayed union, by contrast, describes a that heals more slowly than expected without achieving union within the typical timeframe, but without the malposition characteristic of malunion. These distinctions are critical for guiding treatment, as malunion often requires corrective intervention to restore alignment, whereas focuses on stimulating . Malunions most commonly affect long bones, such as the and , where significant deformities can lead to abnormalities or limb length discrepancies. In contrast, short bones like those in the hand or foot are less prone to clinically significant malunions due to their smaller size and lower mechanical demands, though misalignment can still occur and affect fine motor function.

Incidence and Prevalence

Malunion is a notable complication in fracture management. Overall healing complications, including delayed union, , and malunion, occur in approximately 2-10% of fractures. Rates are generally lower in high-resource settings, with studies reporting malunion in 1-2% of lower extremity fractures over recent decades. In developing regions and conflict zones, however, the incidence is substantially higher, often exceeding 25% due to delays in care, limited surgical access, and reliance on nonoperative methods. Demographic patterns influence malunion prevalence significantly. Among the elderly, and reduced bone quality contribute to higher risks of misalignment during healing, particularly in fragility . In children, malunion is more frequent when growth plates are involved, potentially leading to angular deformities and long-term limb discrepancies. Gender disparities exist, with some studies showing higher rates in females, potentially linked to age-related loss, while males may experience elevated overall incidence from high-energy trauma mechanisms. Temporal trends indicate a decline in malunion rates in high-income countries, attributed to advancements in internal fixation techniques such as intramedullary nailing and locking plates, reducing overall complication rates from historical highs. For instance, in distal radius fractures, conservative treatment yields 20-30% malunion rates, compared to 3-10% with modern surgical intervention. Similarly, femoral shaft fractures treated with intramedullary nailing exhibit malunion rates of 5-10%, reflecting improved outcomes over time. Orthopedic registries highlight these reductions, with contemporary rates often under 5% for many fracture types in well-resourced systems.

Etiology and Pathophysiology

Causes

Malunion occurs when a heals in an abnormal position, often due to disruptions during the process, which involves stages of , soft formation, hard formation, and remodeling. Primary causes include inadequate initial reduction of the , where the fragments are not properly aligned before immobilization, leading to persistent displacement. Poor immobilization, such as non-compliance with or insufficient stabilization, allows movement at the site, resulting in misalignment during . High-energy trauma that causes —where the shatters into multiple fragments—further complicates alignment and increases the likelihood of malunion by making precise reduction challenging. Iatrogenic factors arise from treatment errors, including improper surgical techniques like inadequate or pinning that fail to maintain alignment, or delayed intervention that permits initial displacement to become fixed. For instance, in distal radius fractures, secondary displacement after failed closed reduction or commonly leads to malunion. Biological factors contribute through impaired callus formation, where insufficient bridging tissue develops, resulting in angulation, , or overlap of bone ends due to disrupted osteogenesis. This can stem from compromised at the site, hindering the cellular processes necessary for proper union. Mechanical influences, such as excessive loading on the healing , exacerbate malunion by applying stress that deforms the fragile ; for example, early in lower limb s can cause progressive angulation or rotation before the achieves sufficient stability. Unstable fixation devices that do not adequately counteract forces further promote these deformities.

Risk Factors

Several patient-related factors elevate the risk of malunion following a . Advanced age, particularly over 65 years, is associated with slower and increased susceptibility to malunion due to reduced regenerative capacity and higher prevalence of . Comorbidities such as impair vascular supply and osteogenic activity, thereby heightening malunion risk. further compromises bone quality and stability, contributing to improper alignment during healing. Nutritional deficiencies, including insufficiency, disrupt and mineralization, serving as a documented for malunion. Lifestyle factors play a significant role in malunion predisposition. Smoking impairs vascularity and osteoblast function, increasing the risk of impaired fracture healing that can contribute to malunion. Alcohol abuse hinders fracture repair by altering bone metabolism and increasing inflammation, contributing to impaired healing. Obesity exacerbates mechanical stress on fracture sites and promotes systemic inflammation, thereby elevating malunion likelihood. Fracture-specific characteristics also influence malunion probability. Open fractures introduce contamination and soft tissue damage, substantially increasing malunion incidence. scenarios, involving multiple injuries, further compromise healing through systemic hypoperfusion and inflammatory overload. Fractures in anatomically challenging locations, such as the proximal , are prone to displacement and malunion due to poor and complex . Socioeconomic elements contribute to malunion disparities. Limited access to timely orthopedic care in rural or low-resource settings correlates with delayed union and higher complication rates, as evidenced by 2020s analyses showing prolonged times in lower socioeconomic groups.

Clinical Features

Signs and Symptoms

Malunion manifests through a variety of local, functional, and visible signs that arise after a heals in an improper alignment, often becoming evident once initial healing is complete. Patients commonly experience persistent pain at the fracture site, which may persist long after the acute injury phase due to mechanical stress on the malaligned . Swelling and tenderness upon around the affected area are also frequent, reflecting ongoing from altered . Functional impairments are prominent and vary by the location of the malunion. Reduced in the affected limb or often occurs, limiting daily activities such as flexion or rotation. In lower limb malunions, such as those of the or , patients may develop a or due to uneven weight distribution, leading to compensatory movements that exacerbate discomfort. in the limb can result from malalignment, causing during use and . For upper extremity cases, like clavicle malunions, shoulder dysfunction may include restricted motion and pain during overhead activities. Visible signs of deformity are often the most apparent indicators. These include asymmetry from rotational malunion, where the limb appears twisted or misaligned, altering the overall contour. Limb shortening is common, particularly in femoral malunions, where discrepancies of 2-5 cm can occur, leading to noticeable inequality between sides. In severe cases, such as pelvic malunions, rotational deformities exceeding 15 degrees or vertical displacements of 1-2 cm may contribute to observable imbalances in posture or gait. Systemic effects from malunion are typically rare but can involve syndromes stemming from persistent irritation. More commonly, malalignment places extra stress on adjacent joints, potentially accelerating the onset of early through uneven load transfer, as seen in or following lower limb malunions.

Associated Complications

Malunion of fractures can lead to primarily through altered joint , where uneven load distribution accelerates degeneration and joint surface irregularities. In the ankle, for instance, malunited fractures are associated with a 30-50% of developing over time, often due to persistent incongruity in the tibiotalar joint. Musculoskeletal complications from malunion include resulting from disuse or altered mechanics, which weakens surrounding soft tissues and impairs function. Nerve entrapment is another concern, particularly in humeral malunions where the may become compressed by excessive formation, leading to persistent neuropathy or weakness in extension. Chronic instability may also arise, especially in limbs, as angular deformities disrupt normal alignment and ligament balance, predisposing to recurrent . Systemically, malunion in the elderly heightens fall risk due to gait alterations like limping, which compromise balance and mobility in an already vulnerable population. Additionally, the resulting can contribute to psychological effects, including depression, stemming from and functional limitations that disrupt daily activities and . In the long term, malunions in adults typically result in non-progressive deformities that stabilize after healing, though they may cause ongoing functional deficits. In children, however, involvement near growth plates can lead to progressive deformities, as uneven physeal activity causes angular deviations or limb length discrepancies over time.

Diagnostic Approach

History and Physical Examination

The history taking for malunion begins with a detailed inquiry into the initial event, including the mechanism of such as a fall onto an outstretched hand or high-energy trauma, which helps contextualize the 's origin. Patients are questioned about prior treatments, including immobilization methods, surgical interventions, and compliance with rehabilitation protocols, to identify potential contributors to improper . The timeline of is explored, noting the duration since and any delays in union, alongside current functional limitations such as difficulty with daily activities or reduced mobility. Assessments of pain using standardized tools like the visual analog scale (VAS) quantify severity and impact on , while comparisons of preinjury and current activity levels reveal the extent of dysfunction. Patients' perceptions of and associated symptoms, such as persistent aching or weakness, are elicited to gauge subjective burden. Red flags in the history include progressive worsening of pain or function, which may indicate evolving complications, and night pain unrelieved by rest, potentially signaling overlap with or other pathologies requiring urgent evaluation. The physical examination for malunion emphasizes systematic assessment of deformity and function, starting with for visible angular or rotational abnormalities, such as or abnormal limb alignment, often compared to the contralateral side for . delineates areas of tenderness along the healed site, with checks for if residual is suspected, though this is less common in established malunion. observes for limping, compensatory patterns, or abnormal foot progression, providing insight into lower limb involvement. Limb length discrepancy is measured using block techniques, placing wooden blocks under the shorter limb until pelvic levels are even, to quantify that may exceed 2 cm and affect . is evaluated with a at adjacent joints to document restrictions, such as reduced pronation-supination in malunions, while motor strength testing grades power against resistance. Neurovascular status is thoroughly assessed, including distal pulses, sensation, and , to rule out compromise from the . coverage and stability of nearby joints are inspected to identify secondary issues.

Imaging Studies

Plain radiography serves as the initial and primary imaging modality for evaluating malunion, utilizing standard anteroposterior (AP) and lateral views to assess alignment, angulation, and the status of . These views allow visualization of , such as varus or valgus angulation exceeding 10 degrees, which is generally considered abnormal and indicative of clinically significant malunion in long bones like the or . In malunion, radiographs typically reveal healed with bridging across the site, confirming union while highlighting persistent misalignment. Advanced imaging modalities are employed when plain radiographs are insufficient, particularly for complex deformities. Computed tomography (CT) provides detailed three-dimensional (3D) assessment of rotational malalignment, which is especially valuable in femoral malunions where subtle axial deviations may not be apparent on two-dimensional views; multiplanar reconstructions enable precise quantification of torsion and displacement. (MRI) is useful for evaluating associated involvement, such as ligamentous or tendinous injuries secondary to the malaligned bone, offering high-resolution depiction without . Specific measurements on help characterize the extent of malunion. Callus bridging criteria on radiographs involve identifying continuous cortical bridging across at least three of four cortices, indicating stable union despite . shortening is quantified by comparing the affected limb's length to the contralateral side on AP views, with discrepancies greater than 1-2 cm often warranting intervention; CT can enhance accuracy in irregular fractures. Despite their utility, imaging modalities have limitations that must be considered. CT involves , approximately 1-5 mSv per scan for extremity imaging, raising concerns for cumulative risk in younger patients or repeated evaluations, as emphasized in guidelines. Cost-effectiveness analyses from 2020s reviews indicate that while CT improves diagnostic precision in complex cases, routine use may not justify the added expense over plain radiography for straightforward malunions, with recommendations favoring initial X-rays followed by advanced imaging only when clinically indicated.

Treatment Options

Conservative Management

Conservative management is indicated for malunions that are or cause only minimal symptoms, particularly when the does not significantly impair daily function or when surgical risks outweigh potential benefits. For instance, in pediatric upper extremity malunions such as those of the distal , angulations less than 15° may be suitable for nonoperative approaches, as greater deformities often lead to functional limitations requiring intervention. This approach is especially appropriate for stable malunions in low-demand patients or those with comorbidities that contraindicate surgery. Key methods in conservative management include the use of and bracing to provide structural support and maintain alignment during activities. Braces can help position the affected more optimally for or motion, while custom , such as shoe inserts for lower limb malunions, compensate for leg length discrepancies and reduce uneven stress on . plays a central role, focusing on exercises to enhance muscle strength, flexibility, and , thereby minimizing compensatory strain and improving overall function. For example, targeted strengthening and mobilization protocols have been shown to prevent secondary complications like joint in cases of femoral and tibial malunion. Pain management is addressed through nonsteroidal drugs (NSAIDs) or other analgesics to alleviate discomfort associated with the malunion, alongside activity modifications to avoid exacerbating stress on the deformed . Patients are advised to limit high-impact activities and use assistive devices like canes if needed to offload the affected limb. Ongoing monitoring is essential, involving serial clinical examinations and imaging studies such as X-rays to assess for progression of or development of complications. This allows for timely adjustment of conservative strategies or consideration of alternatives if symptoms worsen.

Surgical Interventions

Surgical interventions for malunion primarily involve corrective , a procedure that involves cutting and realigning the deformed to restore anatomical alignment, followed by stable to promote . This approach is indicated for symptomatic deformities that impair function or cause , particularly when conservative measures fail. typically employs locking plates, screws, or intramedullary nails to maintain correction and allow early . For instance, volar locking plates are commonly used in distal radius malunions to provide robust stability without in modest corrections. Site-specific techniques tailor the to the type and location. Closing-wedge are effective for angular , such as dorsal angulation in extra-articular distal malunions, where a dorsal approach facilitates precise resection and plate fixation. Derotational address torsional malalignments, often performed in the or ; in pediatric cases, double-plate fixation after 3D-planned cuts restores pronosupination by up to 93 degrees on average. For femoral malunions, medial open-wedge corrects varus in the distal , using double-plate fixation (medial buttress and lateral locking) to achieve coronal and sagittal alignment without . External fixators, such as the , may be used as an alternative or adjunct for complex cases involving significant shortening or instability. Bone grafting serves as an adjunct for larger defects created during , filling gaps to enhance union rates, though it is not always necessary for smaller corrections. Autologous grafts or allografts are options, with synthetic alternatives like showing union rates of up to 96% in distal radius cases. Optimal timing for is ideally 6 weeks to 3 months post-fracture for early intervention on immature , or up to 12 months to prevent permanent remodeling, allowing adaptation while minimizing arthrosis risk. Recent advances incorporate 3D-printed patient-specific guides and virtual planning, improving precision in multiplanar corrections and reducing residual deformity to 0.7–5.8 degrees, with enhanced functional outcomes like a 35-point score improvement over conventional methods. Minimally invasive techniques, such as fixation in derotational osteotomies, further decrease complications and avoid hardware removal in select pediatric cases. These innovations, prominent in 2025 orthopedic literature, facilitate complex upper and lower extremity reconstructions with lower revision rates.

Prognosis and Prevention

Long-term Outcomes

The long-term outcomes of malunion management, particularly following surgical correction such as , demonstrate high rates of functional improvement in the majority of patients. Studies report success rates ranging from 80% to 90% in achieving union and satisfactory functional recovery, with good or excellent results observed in approximately 79% to 92% of cases depending on the anatomical site, such as the or . For instance, intramedullary nailing for tibial shaft malunions yields a 92% union rate at one year, while corrective for distal malunions result in significant pain relief and restored daily activities in the majority of patients. However, residual pain persists in some individuals postoperatively, often linked to incomplete alignment correction or underlying degeneration. Patient age influences recovery trajectories, with younger individuals typically experiencing faster healing and better functional restoration due to superior and fewer comorbidities, whereas advanced age may prolong rehabilitation without necessarily compromising overall union rates. Functional metrics post-treatment highlight substantial gains in and daily performance. For upper extremity malunions, such as those of the distal radius, the Disabilities of the Arm, Shoulder, and Hand () score often improves from preoperative levels around 50-60 to 20-25 at long-term follow-up, indicating reduced and enhanced and . In lower limb cases, patients commonly return to work or preinjury activities within 3 to 6 months after , with return-to-work rates reaching 78% by six months for malunions treated operatively; this timeline is influenced by the extent of correction and occupational demands. Overall, these metrics reflect a shift toward normalized and independence, though full recovery may extend to 12 months or more in complex cases. Failure modes after malunion are infrequent but noteworthy. Re-malunion occurs in a small percentage of cases, typically due to inadequate fixation or noncompliance with immobilization. Hardware-related issues, including failure or necessitating removal, affect some , particularly in lower extremity procedures where mechanical stress is higher. These complications rarely lead to complete failure but can delay functional recovery. Longitudinal studies underscore the durability of these outcomes while highlighting risks of secondary pathology. Ten-year follow-ups reveal that while functional scores remain stable with low reoperation rates, develops in approximately 40% of distal malunion cases, contributing to late-onset or ; for tibial malunions, risk is 10% to 30% in plateau-involving deformities over similar periods. These findings, drawn from cohorts tracked for 10 to 22 years, emphasize the importance of early correction to mitigate degenerative changes, though malunion itself does not always directly cause excess in all sites like the femoral shaft.

Preventive Measures

Preventing malunion begins with optimal acute of fractures, emphasizing prompt anatomical reduction and immobilization to ensure proper alignment during . For unstable fractures, open reduction and (ORIF) using plates, screws, or is recommended to maintain position and minimize displacement risks. Closed reduction followed by casting or bracing suffices for fractures, provided regular follow-up confirms alignment. Patient education plays a crucial role in prevention, focusing on compliance with immobilization protocols, weight-bearing restrictions, and follow-up appointments to detect early misalignment. Smoking cessation programs are particularly vital, as tobacco use impairs vascularity and delays healing; quitting can significantly reduce overall complications, including risks of poor alignment. Systemic approaches enhance prevention through multidisciplinary care in specialized trauma centers, where coordinated orthopedic, vascular, and rehabilitation teams address high-risk cases to lower complication rates. Nutritional supplementation with calcium and supports overall and may aid in fracture prevention, particularly in osteoporotic patients or those with deficiencies, though evidence for direct effects on or mitigating delayed union leading to malunion is limited. Guidelines from organizations like the Orthopaedic Trauma Association (OTA) and American Academy of Orthopaedic Surgeons (AAOS), updated through 2023-2025, stress early intervention for high-risk fractures, such as open or comminuted types, with timely debridement, stabilization, and monitoring to avert malunion. Recent 2024 evidence-based best practices for open fractures further emphasize optimizing factors and antimicrobial strategies to prevent complications like fracture-related infections that can contribute to malunion.

References

  1. https://my.clevelandclinic.org/health/diseases/malunion-nonunion-fracture
  2. https://www.ncbi.nlm.nih.gov/books/NBK554385/
  3. https://orthoinfo.aaos.org/en/diseases--conditions/malunion-in-the-lower-limb/
  4. https://pubmed.ncbi.nlm.nih.gov/33044151/
  5. https://pmc.ncbi.nlm.nih.gov/articles/PMC10882945/
  6. https://pmc.ncbi.nlm.nih.gov/articles/PMC8956117/
  7. https://www.ncbi.nlm.nih.gov/medgen/56386
  8. https://orthoinfo.aaos.org/en/diseases--conditions/nonunions/
  9. https://www.orthobullets.com/basic-science/9069/nonunion-and-bone-defects
  10. https://pmc.ncbi.nlm.nih.gov/articles/PMC9804201/
  11. https://pmc.ncbi.nlm.nih.gov/articles/PMC6542911/
  12. https://www.researchgate.net/publication/300568554_Management_of_Delayed_Union_Non-Union_and_Mal-Union_of_Long_Bone_Fractures
  13. https://pubmed.ncbi.nlm.nih.gov/28488041/
  14. https://pmc.ncbi.nlm.nih.gov/articles/PMC4212425/
  15. https://www.childrenshospital.org/conditions/malunion-fracture
  16. https://upload.orthobullets.com/journalclub/free_pdf/35843762_35843762.pdf
  17. https://pubmed.ncbi.nlm.nih.gov/30166239/
  18. https://journals.lww.com/egoj/fulltext/2023/58020/metacarpals_and_phalanges_malunion__a_narrative.1.aspx
  19. https://www.orthobullets.com/trauma/423135/distal-radius-malunion
  20. https://www.sciencedirect.com/science/article/pii/S0020138320309554
  21. https://jorthoptraumatol.springeropen.com/articles/10.1186/s10195-025-00843-0
  22. https://www.sciencedirect.com/science/article/pii/S089990072100054X
  23. https://pmc.ncbi.nlm.nih.gov/articles/PMC5129177/
  24. https://boneandjoint.org.uk/Article/10.1302/2046-3758.116.BJR-2021-0596.R1
  25. https://www.upmc.com/services/orthopaedics/conditions/malunion-nonunion
  26. https://eor.bioscientifica.com/view/journals/eor/7/7/EOR-21-0137.xml
  27. https://pmc.ncbi.nlm.nih.gov/articles/PMC6360674/
  28. https://www.orthobullets.com/trauma/12283/proximal-humerus-fracture-nonunion-and-malunion
  29. https://pmc.ncbi.nlm.nih.gov/articles/PMC10358791/
  30. https://blog.orthoindy.com/2019/07/02/malunion-vs-nonunion-fractures/
  31. https://www.precisionsurgerycenter.org/malunion-of-a-fracture-orthopedic-spine-surgeon-macomb-michigan/
  32. https://pmc.ncbi.nlm.nih.gov/articles/PMC8355657/
  33. https://www.limblength.org/conditions/malunion/
  34. https://pmc.ncbi.nlm.nih.gov/articles/PMC9415997/
  35. https://www.jfasap.com/abstractArticleContentBrowse/JFASAP/25559/JPJ/fullText
  36. https://revistasccot.org/index.php/rccot/article/view/180
  37. http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-29362019000100030
  38. https://pure.eur.nl/files/86622329/children_10_00195_with_cover.pdf
  39. https://www.hss.edu/globalassets/files/LL/LL-Nonunions-and-Malunions.pdf
  40. https://pmc.ncbi.nlm.nih.gov/articles/PMC3923744/
  41. https://www.ncbi.nlm.nih.gov/books/NBK613072/
  42. https://pmc.ncbi.nlm.nih.gov/articles/PMC6142797/
  43. https://www.ncbi.nlm.nih.gov/books/NBK574580/
  44. https://musculoskeletalkey.com/diagnosing-the-malunited-distal-radius/
  45. https://journals.lww.com/jbjsoa/fulltext/2018/12000/long_bone_union_accurately_predicted_by_cortical.9.aspx
  46. https://link.springer.com/article/10.1007/s00068-024-02755-w
  47. https://www.mdpi.com/2075-1729/14/9/1177
  48. https://www.sciencedirect.com/science/article/pii/S0020138320306872
  49. https://link.springer.com/article/10.1007/s00402-018-2912-2
  50. https://www.fda.gov/radiation-emitting-products/medical-x-ray-imaging/what-are-radiation-risks-ct
  51. https://guidelines.carelonmedicalbenefitsmanagement.com/wp-content/uploads/2023/04/PDF-Imaging-of-the-Extremities-2023-09-10.pdf
  52. https://www.semanticscholar.org/paper/793da9fed16650567053dcc4bb0fe570a28448d3
  53. https://pmc.ncbi.nlm.nih.gov/articles/PMC4404777/
  54. https://www.oint.org/lower-extremity-malalignment-services-frisco-mckinney-dallas-tx.html
  55. https://pmc.ncbi.nlm.nih.gov/articles/PMC10741186/
  56. https://pmc.ncbi.nlm.nih.gov/articles/PMC10885743/
  57. https://pmc.ncbi.nlm.nih.gov/articles/PMC10642188/
  58. https://pubmed.ncbi.nlm.nih.gov/21915577/
  59. https://pmc.ncbi.nlm.nih.gov/articles/PMC11602411/
  60. https://pmc.ncbi.nlm.nih.gov/articles/PMC6430482/
  61. https://pmc.ncbi.nlm.nih.gov/articles/PMC9789287/
  62. https://journals.sagepub.com/doi/10.1177/17531934251327286
  63. https://pmc.ncbi.nlm.nih.gov/articles/PMC2706342/
  64. https://www.tandfonline.com/doi/full/10.1080/2000656X.2021.1899934
  65. https://pmc.ncbi.nlm.nih.gov/articles/PMC7306028/
  66. https://pubmed.ncbi.nlm.nih.gov/32427816/
  67. https://pmc.ncbi.nlm.nih.gov/articles/PMC11799726/
  68. https://publishingimages.s3.amazonaws.com/eZineImages/PracticePerfect/781/Postoperative-Complications-and-Reoperation-Rates-Following-Open-Reduction.pdf
  69. https://boneandjoint.org.uk/Article/10.1302/0301-620X.90B5.19448
  70. https://pubmed.ncbi.nlm.nih.gov/20656289/
  71. https://www.mcw.edu/-/media/MCW/Departments/Orthopaedic-Surgery/Patient-Education---Smoking-and-Orthopaedic-Surgery.pdf
  72. https://pmc.ncbi.nlm.nih.gov/articles/PMC7286246/
  73. https://pubmed.ncbi.nlm.nih.gov/29931664/
  74. https://journals.lww.com/otainternational/fulltext/2024/05001/open_fractures__evidence_based_best_practices.4.aspx
  75. https://www.aaos.org/globalassets/quality-and-practice-resources/distal-radius/drfcpg.pdf
  76. https://pmc.ncbi.nlm.nih.gov/articles/PMC11064778/
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