The clinical relevance of posttraumatic avascular necrosis of the humeral head

Twenty-five patients with a partial or complete collapse of the humeral hea d caused by post-traumatic avascular necrosis underwent clinical and radiol ogic evaluation at an average of 7.5 years (range 2.3 to 17.6 years) after having an underlying proximal humeral fracture. Posttraumatic humeral head necrosis was always associated with disability The overall shoulder functio n as assessed with the Constant score was 46 points, corresponding to a fun ctional shoulder value of 51% of an age- and sex-matched normal control gro up. The clinical outcome was significantly related to the anatomic alignmen t of the fragments of the humerus by the time of healing. In 13 patients (g roup 1) treatment resulted in an anatomic or nearly anatomic healing of the Fracture, and in 12 other patients (group 2) avascular necrosis and collap se ensued in addition to malunion of I or more of the fracture fragments. S ubjective overall out come (P < .0001) and pain (P < .0001) were significan tly better in group 1. Active anterior elevation averaged 125 degrees in gr oup I and 80 degrees in group 2 (P =.0007), and abduction averaged 110 degr ees in group I and 63 degrees in group 2 (P = .007). The relative shoulder score according to Constant was 65% of an age- and sex- matched normal popu lation For group I and 41% for group 2 (P = .001). The results obtained in group 1 were comparable to chose reported after hemiarthroplasty For comple x humeral fractures. A proximal humeral fracture that is at risk for avascu lar necrosis has to be reduced anatomically if joint-preserving treatment i s selected. IF anatomic reduction cannot be obtained other treatment option s such as arthroplasty should be considered.