Document Detail


Operative treatment of malunion of a fracture of the proximal aspect of the humerus.
MedLine Citation:
PMID:  9801217     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
We retrospectively reviewed the medical records, operative reports, and preoperative and postoperative radiographs of thirty-nine 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; twenty-eight patients), incongruity of the articular surface (type II; twenty-six patients), and malalignment of the articular segment (type III; sixteen patients). Soft-tissue abnormalities, such as soft-tissue contracture, a tear of the rotator cuff, and impingement, were also recorded. At an average of forty-four months (range, twelve to fifty-three 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 twenty-seven patients (69 per cent) and unsatisfactory for the remaining twelve (31 per cent) at the latest follow-up evaluation. Of the twenty-seven patients who had a satisfactory result, twenty-six (96 per cent) had had complete operative correction of all osseous and soft-tissue abnormalities. Of the twelve patients who had an unsatisfactory result, four had had complete operative correction of these abnormalities (p < 0.0001). Twenty-six patients (67 per cent) had incongruity of the glenohumeral joint at the time of presentation. Twenty-three of these patients had the incongruity corrected with prosthetic arthroplasty (twenty-two) or arthrodesis of the glenohumeral joint (one); the result was satisfactory for seventeen (74 per cent). In contrast, the result was unsatisfactory for all three patients in whom the incongruity had not been corrected at the time of the operation (p = 0.01). Eleven patients had malposition of the greater or lesser tuberosity but a congruent joint surface preoperatively. Ten patients in this group were managed with either osteotomy of the tuberosity or acromioplasty, and nine 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.
Authors:
P K Beredjiklian; J P Iannotti; T R Norris; G R Williams
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of bone and joint surgery. American volume     Volume:  80     ISSN:  0021-9355     ISO Abbreviation:  J Bone Joint Surg Am     Publication Date:  1998 Oct 
Date Detail:
Created Date:  1998-11-24     Completed Date:  1998-11-24     Revised Date:  2010-10-25    
Medline Journal Info:
Nlm Unique ID:  0014030     Medline TA:  J Bone Joint Surg Am     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1484-97     Citation Subset:  AIM; IM    
Affiliation:
Department of Orthopaedic Surgery, University of Pennsylvania Health System, Philadelphia 19104, USA.
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MeSH Terms
Descriptor/Qualifier:
Acromion / surgery
Activities of Daily Living
Adult
Aged
Arthralgia / surgery
Arthrodesis
Arthroplasty, Replacement
Contracture / etiology,  surgery
Follow-Up Studies
Fractures, Malunited / pathology,  physiopathology,  radiography,  surgery*
Humans
Humerus / surgery
Middle Aged
Osteotomy / methods
Patient Satisfaction
Range of Motion, Articular / physiology
Retrospective Studies
Rotator Cuff / injuries,  surgery
Rupture
Shoulder Fractures / pathology,  physiopathology,  radiography,  surgery*
Shoulder Joint / physiopathology,  surgery
Treatment Outcome
Comments/Corrections
Erratum In:
J Bone Joint Surg Am 1999 Mar;81(3):439

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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