We retrospectively reviewed the medical records, operative reports, and preoperative and postoperative radiographs of 39 patients who had been managed operatively for malunion of a fracture of the proximal aspect of the humerus. The malunions were categorized according to the presence of osseous abnormalities, including malposition of the greater or lesser tuberosity (type I; 28 patients), incongruity of the articular surface (type II; 26 patients), and malalignment of the articular segment (type III; 16 patients). Soft-tissue abnormalities, such as soft-tissue contracture, a tear of the rotator cuff, and impingement, were also recorded. At an average of 44 months (range, 12 to 53 months) postoperatively, the patients were assessed for pain relief, the range of motion of the shoulder, and the ability to perform activities of daily living. The result was satisfactory for 27 patients (69 per cent) and unsatisfactory for the remaining 12 (31 per cent) at the latest follow-up evaluation. Of the 27 patients who had a satisfactory result, 26 (96 per cent) had had complete operative correction of all osseous and soft-tissue abnormalities. Of the 12 patients who had an unsatisfactory result, 4 had had complete operative correction of these abnormalities (p < 0.0001). 26 patients (67 per cent) had incongruity of the glenohumeral joint at the time of presentation. 23 of these patients had the incongruity corrected with prosthetic arthroplasty (22) or arthrodesis of the glenohumeral joint (one); the result was satisfactory for 17 (74 per cent). In contrast, the result was unsatisfactory for all 3 patients in whom the incongruity had not been corrected at the time of the operation (p = 0.01). 11 patients had malposition of the greater or lesser tuberosity but a congruent joint surface preoperatively. 10 patients in this group were managed with either osteotomy of the tuberosity or acromioplasty, and 9 of them had a satisfactory result at the latest follow-up evaluation. The result was unsatisfactory for one patient who was managed with only correction of a soft-tissue contracture (that is, no treatment of the malposition) (p = 0.05). Both osseous and soft-tissue abnormalities were identified as the cause of pain and stiffness in patients who had malunion of a fracture of the proximal aspect of the humerus. We concluded that operative management of these patients is successful only if all osseous and soft-tissue abnormalities are corrected at the time of the operation.
Copyright remains with the authors and publisher.
We retrospectively reviewed the medical records, operative reports, and preoperative and postoperative radiographs of 39 patients who had been managed operatively for malunion of a fracture of the proximal aspect of the humerus. The malunions were categorized according to the presence of osseous abnormalities, including malposition of the greater or lesser tuberosity (type I; 28 patients), incongruity of the articular surface (type II; 26 patients), and malalignment of the articular segment (type III; 16 patients). Soft-tissue abnormalities, such as soft-tissue contracture, a tear of the rotator cuff, and impingement, were also recorded. At an average of 44 months (range, 12 to 53 months) postoperatively, the patients were assessed for pain relief, the range of motion of the shoulder, and the ability to perform activities of daily living. The result was satisfactory for 27 patients (69 per cent) and unsatisfactory for the remaining 12 (31 per cent) at the latest follow-up evaluation. Of the 27 patients who had a satisfactory result, 26 (96 per cent) had had complete operative correction of all osseous and soft-tissue abnormalities. Of the 12 patients who had an unsatisfactory result, 4 had had complete operative correction of these abnormalities (p < 0.0001). 26 patients (67 per cent) had incongruity of the glenohumeral joint at the time of presentation. 23 of these patients had the incongruity corrected with prosthetic arthroplasty (22) or arthrodesis of the glenohumeral joint (one); the result was satisfactory for 17 (74 per cent). In contrast, the result was unsatisfactory for all 3 patients in whom the incongruity had not been corrected at the time of the operation (p = 0.01). 11 patients had malposition of the greater or lesser tuberosity but a congruent joint surface preoperatively. 10 patients in this group were managed with either osteotomy of the tuberosity or acromioplasty, and 9 of them had a satisfactory result at the latest follow-up evaluation. The result was unsatisfactory for one patient who was managed with only correction of a soft-tissue contracture (that is, no treatment of the malposition) (p = 0.05). Both osseous and soft-tissue abnormalities were identified as the cause of pain and stiffness in patients who had malunion of a fracture of the proximal aspect of the humerus. We concluded that operative management of these patients is successful only if all osseous and soft-tissue abnormalities are corrected at the time of the operation.
Copyright remains with the authors and publisher.