Corrective Surgical Neck Osteotomy for Varus Malunion of the Proximal Humerus

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Abstract

Surgical neck malunions after proximal humerus fractures can be associated with shoulder pain and dysfunction. The purpose of this study was to describe a technique and outcome of corrective osteotomy. This was a retrospective study of 14 patients with a symptomatic varus surgical neck malunion without glenohumeral arthritis who were treated at 2 centers with a valgus, closing wedge surgical neck osteotomy and fixed angle, blade plate fixation. The mean age was 60 years old (range, 44 to 78 y), and the mean interval between original injury and treatment was 24 months (range, 3 to 180 mo). The mean preoperative neck-shaft deformity was 40 degrees (range, 25 to 70 degrees). Outcomes were assessed at a mean of 33.4 months with a visual analog scale for pain, the Disability of the Arm, Shoulder, and Hand score, shoulder range of motion, and plain radiographic assessment of the bony correction. The mean neck-shaft angle correction was 33 degrees (range, 17 to 52 degrees). There were increases in range of motion in all planes, with an increase of 30 degrees in active forward elevation, 9 degrees of active external rotation, and 1 vertebral level in passive internal rotation. All patients had improvements in pain, and the mean final Disability of the Arm, Shoulder, and Hand score was 20 (11 to 42). There was 1 infection and 2 patients with nonunion that required revision, one of which was successfully united with revision surgery and bone grafting, whereas the other was converted to a total shoulder arthroplasty. In the absence of associated glenohumeral arthritis corrective surgical neck osteotomy is an effective treatment for varus surgical neck malunion.

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