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Health condition

Bone deformity after injury and infection, malunion, nonunion and modern limb reconstruction.

After a bad fracture, a growth-plate injury or a bone or joint infection, the bone can heal in the wrong shape, not heal at all, or leave one limb shorter than the other. Modern UK limb-reconstruction teams can put a lot of it right.

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A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Why trust this guide

  • 01

    Editorial team

    Written by our editorial team from the UK sources listed on each page.

  • 02

    Sourced from guidance

    Checked against BOA, BLRS, NICE and specialist limb-reconstruction unit standards, listed at the end.

  • 03

    Current for 2026

    Reflects modern UK limb-reconstruction practice, including hexapod frames, PRECICE magnetic nails and Masquelet technique.

Key facts

Bone deformity at a glance.

The essentials, in plain English: what post-traumatic and post-infectious deformity actually is, and how UK limb-reconstruction units approach it today.

  • What it is

    Structural bone abnormality after a fracture, growth-plate injury or bone/joint infection, including malunion, nonunion, limb length discrepancy and post-osteomyelitis deformity.

  • Malunion

    A fracture that has healed in an unacceptable position: angular, rotational, shortened or translated.

  • Nonunion

    Failure of a fracture to heal, classified as atrophic, hypertrophic, oligotrophic or septic (infected).

  • Limb length

    Discrepancy after fracture, growth-plate arrest (Salter-Harris) or infection: usually addressed with insoles, shortening or lengthening.

  • Sequelae of infection

    Osteomyelitis and septic arthritis can leave sequestrum, involucrum, sinus tracts, bone loss and destroyed joints, especially in children.

  • Reconstruction

    Corrective osteotomy, Ilizarov or Taylor Spatial Frame, PRECICE magnetic nails and bone transport are all UK-available options.

Why this guide matters

Post-traumatic and post-infectious bone problems, decoded.

The categories, sequelae and the reconstructive options shape everything that follows on this page.

  • Post-traumatic deformity

    Malunion (angular, rotational, shortening, translation) and nonunion (atrophic, hypertrophic, oligotrophic or septic) after fractures, plus limb length discrepancy from growth-plate injury.

  • Post-infectious sequelae

    Osteomyelitis can leave sequestrum, involucrum, sinus, bone loss and destroyed joints. Septic arthritis, TB (Pott spine, Bickerstaff hip) and polio all cause distinct patterns of deformity.

  • Modern reconstruction

    UK teams use corrective osteotomy, Ilizarov and Taylor Spatial Frame, PRECICE magnetic nails, Masquelet technique, bone transport and guided growth in children.

How the assessment is done

From first appointment to a reconstruction plan.

The steps a UK orthopaedic team will normally follow so you know what to expect and why each test matters.

  1. 01

    Assessing

    Focused history

    The original injury, operations, infections, antibiotics, smoking, diabetes and medications that affect bone healing.

  2. 02

    Assessing

    Clinical examination

    Gait, deformity, Galeazzi test, clinical limb length, block measurement, range of motion, neurology, vascular status and skin/soft-tissue quality.

  3. 03

    Assessing

    Plain radiographs

    Orthogonal X-rays of the whole bone, full-length standing views and a scanogram for measured limb length discrepancy.

  4. 04

    Confirming

    Cross-sectional imaging

    CT with 3D reconstruction for deformity and nonunion planning; MRI for infection, soft-tissue envelope and vascular assessment.

  5. 05

    Confirming

    Infection workup

    ESR, CRP, white cell count, bone scan, tagged white-cell scan and image-guided biopsy with prolonged culture where infection is possible.

  6. 06

    Planning

    Whole-body and functional workup

    EOS low-dose whole-body imaging, gait analysis and DEXA where bone quality or osteoporosis is a concern.

  7. 07

    Planning

    Referral to a limb-reconstruction MDT

    Complex nonunion, deformity, infection or bone loss belong in a specialist unit with orthopaedic, plastics, microbiology and rehabilitation input.

Typical pathway: from first orthopaedic visit to a shared reconstruction plan in a few clinic visits.

Presentation

What post-traumatic and post-infectious deformity looks like.

The mix of visible deformity, functional loss, gait change and secondary joint pain, plus the features that mean it is time to escalate to a specialist.

  • Visible deformity

    Angulation, rotation, shortening or translation you or a clinician can see, often obvious on comparison with the other side.

  • Limb length discrepancy

    A short leg, pelvic tilt or shoe-raise need; in children, discrepancy grows with the child.

  • Pain and functional loss

    Pain at the deformity or fracture site, difficulty weight-bearing, stiffness and reduced walking distance.

  • Neurovascular symptoms

    Numbness, pins and needles, weakness or colour and temperature change from tethered or compressed nerves and vessels.

  • Skin and sinus problems

    Adherent scars, ulceration over bony prominences, discharging sinus tracts and poor prosthetic fit after amputation.

  • Gait abnormality

    Trendelenburg, antalgic, short-limb or circumduction gait, often with compensatory back and hip pain.

  • Secondary joint pain

    Adjacent knee, hip, ankle or spinal pain from altered mechanics and early secondary osteoarthritis.

  • Red flag: infection features

    New pain, swelling, redness, fever, discharge or systemic upset in previously operated or infected bone: seek urgent orthopaedic review.

Treatment

How UK limb-reconstruction teams treat it.

Options range from insoles and physiotherapy to corrective osteotomy, external frames, PRECICE magnetic nails, staged infection surgery and, when needed, amputation with prosthetics.

  • Non-operative care

    Footwear, orthotics, shoe raise, insoles, braces, walking aids and physiotherapy for mild, non-progressive deformity, elderly or high-risk patients.

  • Corrective osteotomy

    Planned bone cut with closing wedge, opening wedge, rotational or dome osteotomy to realign the limb (see /treatments/osteotomy-realignment-surgery/).

  • External fixation and frames

    Ilizarov, Taylor Spatial Frame and other hexapod devices for gradual correction, limb lengthening and bone transport (see /treatments/limb-lengthening-frame/).

  • Internal fixation and PRECICE nail

    Plates, intramedullary nails and PRECICE magnetic lengthening nails for internal lengthening and stable fixation.

  • Nonunion surgery

    Debridement, revision fixation and bone graft (iliac crest, RIA, BMP, BMAC, allograft) or Masquelet induced-membrane technique for segmental defects.

  • Infected nonunion protocol

    Two-stage surgery with radical debridement, antibiotic spacer or cement beads, culture-directed long-course antibiotics and delayed reconstruction in a bone-infection unit.

  • Paediatric guided growth

    Hemi-epiphysiodesis and eight-plate techniques to correct angular deformity or limb length discrepancy while the child is still growing.

  • Amputation and prosthetics

    Considered for unsalvageable limbs, persistent osteomyelitis, severe deformity or poor function, followed by prosthetics, orthotics and rehabilitation.

Specialist centres

Where complex reconstruction happens in the UK.

Complex limb reconstruction is concentrated in tertiary centres including the Royal National Orthopaedic Hospital (RNOH Stanmore), Nuffield Orthopaedic Centre Oxford, Robert Jones and Agnes Hunt Oswestry, Sheffield, Newcastle, Cardiff, Bristol, Cambridge and Aberdeen. TB spine (Pott disease) is co-managed with infectious diseases and spinal surgery, with antituberculous therapy alongside decompression and stabilisation where indicated.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP or orthopaedic surgeon knows your history and imaging and can tell you which parts apply to you. If in doubt, get seen.

  • British Orthopaedic Association (BOA) Standards for Trauma (BOAST): open fractures, non-union and bone infection.

  • British Limb Reconstruction Society (BLRS): guidance on limb reconstruction, deformity correction and limb lengthening.

  • NICE. Complex fractures and non-union management guidance.

  • Bone and Joint Infection Registry (BAJIR) and specialist UK bone-infection unit standards.

Red flags

When deformity or infection needs urgent attention.

Most post-traumatic deformity can be planned electively. These are the features that cannot wait for a routine clinic slot.

  • Suspected infection

    New pain, redness, swelling, fever or discharge in previously injured or operated bone: urgent orthopaedic assessment to rule out osteomyelitis or infected nonunion.

  • Acute neurovascular compromise

    Sudden numbness, weakness, cold or pulseless limb needs same-day emergency review.

  • Open wound or exposed metalwork

    Skin breakdown over a plate, nail or bone always needs urgent specialist input to prevent deep infection.

  • Progressive deformity in a child

    Worsening angulation or limb length discrepancy after a growth-plate injury (Salter-Harris) needs paediatric orthopaedic follow-up.

  • Spinal deformity with neurology

    A worsening kyphosis or gibbus (for example in Pott disease of the spine) with weakness, numbness or bowel/bladder change is an emergency.

  • Non-healing sinus or ulcer

    A long-standing discharging sinus over bone can rarely undergo malignant change (Marjolin ulcer) and needs biopsy.

  • Post-polio deterioration

    New weakness, pain or deformity years after polio (post-polio syndrome) deserves neurology and orthotics review.

  • Severe systemic upset

    Sepsis features (high fever, low blood pressure, confusion) alongside bone pain need emergency care via 999 or A and E.

  • Suspected Marjolin change

    Any nodular, bleeding or rapidly changing lesion in a chronic sinus or scar should be biopsied urgently.

Living with it

Reconstruction is a marathon, not a sprint.

Four things that make the biggest difference over months of frames, physiotherapy and clinic visits: the right team, patience, movement and mental wellbeing.

A quiet reminder

Small daily habits, kept up for months.

Pin care, physiotherapy exercises, weight-bearing progression and gentle activity: they add up to a much better final result than any single heroic effort.

  1. 01 Team

    Get into the right MDT

    Complex deformity, nonunion and infection are best managed by UK limb-reconstruction units such as RNOH Stanmore, Nuffield Oxford, Robert Jones and Agnes Hunt, Sheffield, Newcastle, Cardiff, Bristol, Cambridge and Aberdeen.

  2. 02 Time

    Reconstruction is a journey

    Frames, lengthening and staged infection surgery often take months. Pace yourself, plan work and family life around it, and lean on your specialist nurse.

  3. 03 Movement

    Physiotherapy is not optional

    Range of motion, strengthening and gait retraining protect the joints above and below, and make the final result feel worth the surgery.

  4. 04 Wellbeing

    Mind the mental load

    Long treatments, visible frames and altered body image are tough. Ask about psychology, peer support and occupational therapy: they are part of proper reconstruction care.

Frequently asked

Everything we get asked about bone deformity.

Quick answers on malunion, nonunion, limb length discrepancy, frames and when amputation is on the table.

  • What is a malunion and how is it different from a nonunion?

    A malunion is a fracture that has healed, but in an unacceptable position: angulated, rotated, shortened or translated. A nonunion is a fracture that has failed to heal at all, and is classified as atrophic, hypertrophic, oligotrophic or septic (infected). Both can cause pain, deformity and functional loss and often benefit from reconstructive surgery.

  • Can bone infection cause deformity later in life?

    Yes. Osteomyelitis can leave dead bone (sequestrum), new bone shell (involucrum), chronic sinus tracts, bone loss and, in children, growth-plate damage that leads to limb length discrepancy and angular deformity. Septic arthritis can destroy cartilage and cause secondary osteoarthritis or ankylosis. Modern UK bone-infection units offer staged reconstruction with debridement, antibiotic spacers and bone transport.

  • How is limb length discrepancy treated?

    Small differences are managed with insoles or shoe raises. In growing children, hemi-epiphysiodesis or guided growth on the longer leg can even things out. In adults, options include shortening osteotomy of the longer limb or lengthening the shorter limb with an external frame (Ilizarov or Taylor Spatial Frame) or an internal PRECICE magnetic nail.

  • What is the Ilizarov or hexapod frame for?

    External fixators such as the Ilizarov and Taylor Spatial Frame allow gradual, controlled correction of complex deformity, limb lengthening and bone transport for segmental bone loss. They rely on distraction osteogenesis: slowly pulling bone apart at a cut so new bone forms in the gap. Frames are usually worn for several months and need close specialist follow-up.

  • Do I need surgery, or can I manage without?

    Not always. Mild, non-progressive deformity in an older or medically complex patient may be well managed with footwear, orthotics, physiotherapy and walking aids. Surgery is usually offered when pain, function, skin problems, secondary osteoarthritis or progression justify the risks. A limb-reconstruction MDT will talk through what is realistic for you.

  • When is amputation considered?

    Amputation may be considered when the limb is unsalvageable, when infection cannot be controlled, when nonunion has failed repeated reconstruction, or when function, pain and skin are so poor that a well-fitted prosthesis is likely to give a better life than more surgery. It is always a joint decision with the patient, specialist team and rehabilitation and prosthetics services.

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