4 PART VALGUS IMPACTED FRACTURES OF THE P ROXIMAL HUMERUS - GRAFT RECONSTRUCTION - REPORT OF 8 CASES

Purpose of the study We present the results of an original technique f or reconstruction of valgus-impacted humeral head using autologous ili ac bone. Material and Methods Between 1992 and 1993, 8 patients (avera ge age 66 years, range 43 to 79 years) with four-part valgus impacted proximal humeral fractures were operated with the aim of preserving th e humeral head. All fractures were treated with open reduction and wer e stabilized only with autologous bone. This procedure provided fixati on without osteosynthesis. Using a deltopectoral approach the impacted segment of the humeral head was raised, the void was filled with auto logous three-cortical iliac bone graft, and the tuberosities were relo cated with the goal of anatomic reconstruction. The assessment include d clinical examination including Constant's score, radiographic examin ation and MRI examination. Only one patient was not available for the review at follow-up evaluation (minimum 12 months, average 16 months). Results According to Constant's criteria, two results were excellent, two very good. one good, one fair and one patient were considered fai lure. Average Constant's score was 62 average score in comparison with the healthy side was 76 per cent, Radiographic findings showed in all cases healing and incorporation of the graft. MRI results showed only one asymptomatic partial avascular necrosis (14 per cent). Discussion This specific type nf displaced four-part fracture oi the proximal hu merus wich consists of valgus impaction of the head fragment without l ateral displacement has a rate of avascular necrosis lower than that o f other displaced four-part fractures, Blood supply of the articular s egment is maintained via the periosteum extending to the medial part o f the anatomic humeral neck. These data authorized the authors to prop ose a new conservative treatment for four-part valgus impacted proxima l humeral fractures.