[Valgus osteotomy of the subcapital humerus: a reconstructive procedure after post-traumatic malalignement].

AIM: Post-traumatic humerus varus can develop after an insufficient reduction technique. Reduced abduction, anteversion or rotation is seen, often associated with painful impingement. The radiographic sign is a diminished shaft-head angle less than 140 degrees with a consecutive elevation of the greater tubercule above the head rim and a subacromial narrowing. We analysed the data of the Constant score pre- and postcorrectionem.

METHODS

Between 1992 and 1999 we treated 8 patients with post-traumatic humerus varus. The follow-up time lasted for 3 years after the correction procedure. By means of the Constant score we evaluated the pre- and postoperative results. In addition, we measured the radiological changes of the humerus head-shaft angles. Furthermore, we controlled the arm length before and after the corrective osteotomy.

RESULTS

The age at the time of correction averaged 43 years (23 years to 65 years). In 6 patients a closing wedge was performed on the right shoulder and two times on the left side. 2 patients had an additional retrotorsional malalignment, which was corrected by means of derotation. In 5 cases cancellous bone was attached to the osteotomy plane. The average delay between the first and the second operation was 8 months (range from 4 weeks to 12 months). The Constant score improved from 39.5 to 75.5 points. The radiological head-shaft angle increased from 84 degrees to 130 degrees . The arm shortening decreased from 2 cm to less than 1 cm. Osseous consolidation of the osteotomy was established after 8.5 weeks. In one case we saw a pseudarthrotic osteotomy plane and treated it by plate extension and cancellous bone grafting.

CONCLUSION

The valgus osteotomy of the humeral neck is an extra-articular reconstructive procedure to correct a malpositioning between humeral head and shaft. It improves both radiological and clinical results. It is a demanding procedure regarding indication and operative technique.