OPERATIVE TREATMENT OF MALUNION OF A FRACTURE OF THE PROXIMAL ASPECT OF THE HUMERUS

We retrospectively reviewed the medical records, operative reports, an d preoperative and postoperative radiographs of thirty-nine patients w ho had been managed operatively for malunion of a fracture of the prox imal aspect of the humerus, The malunions were categorized according t o the presence of osseous abnormalities, including malposition of the greater or lesser tuberosity (type I; twenty-eight patients), incongru ity of the articular surface (type II; twenty-six patients), and malal ignment of the articular segment (type III; sixteen patients). Soft-ti ssue abnormalities, such as soft-tissue contracture, a tear of the rot ator cuff, and impingement, were also recorded. At an average of forty -four months (range, twelve to fifty-three months) postoperatively, th e patients were assessed for pain relief, the range of motion of the s houlder, and the ability to perform activities of daily living. The re sult was satisfactory for twenty-seven patients (69 per cent) and unsa tisfactory for the remaining twelve (31 per cent) at the latest follow -up evaluation, Of the twenty-seven patients who had a satisfactory re sult, twenty-six (96 per cent) had had complete operative correction o f all osseous and soft-tissue abnormalities. Of the twelve patients wh o had an unsatisfactory result, four had had complete operative correc tion of these abnormalities (p < 0.0001). Twenty-six patients (67 per cent) had incongruity of the glenohumeral joint at the time of present ation. Twenty-three of these patients had the incongruity corrected wi th prosthetic arthroplasty (twenty-two) or arthrodesis of the glenohum eral joint (one); the result was satisfactory for seventeen (74 per ce nt). In contrast, the result was unsatisfactory for all three patients in whom the incongruity had not been corrected at the time of the ope ration (p = 0.01). Eleven patients had malposition of the greater or l esser tuberosity but a congruent joint surface preoperatively Ten pati ents in this group were managed with either osteotomy of the tuberosit y or acromioplasty; and nine of them had a satisfactory result at the latest follow-up evaluation. The result was unsatisfactory for one pat ient who was managed with only correction of a soft-tissue contracture (that is, no treatment of the malposition) (p = 0.05). Both osseous a nd soft-tissue abnormalities were identified as the cause of pain and stiffness in patients who had malunion of a fracture of the proximal a spect of the humerus, We concluded that operative management of these patients is successful only if all osseous and soft-tissue abnormaliti es are corrected at the time of the operation.