We report a case of delayed union of 4-part valgus impacted fracture of proximal humerus with restriction of the range of motion caused by deformity which was satisfactorily treated with rotator cuff reconstruction procedure.
A 37-year old man suffered a proximal humerus fracture by motorcycle accident. After conservative therapy for about two months, he consulted our hospital about prolonged severe pain and severe restriction of the range of motion. The X-ray and the CT showed valgus impacted humerus head and medially displaced fragments of both the greater and lesser tuberosity. In the operation, the humeral head and shaft were already fused in valgus position. The fragments of both the greater and lesser tuberosity were removed and the rotator cuff was repaired on the articular surface of which cartilage was removed.
After 6 years, shoulder range of motion improved from 40 to 160 degrees in anterior elevation and from 10 to 60 degrees in external rotation. He was very satisfied with the clinical result.
Although malunion of 4-part proximal humerus fracture is usually treated by prosthetic arthroplasty, we considered that the humeral head should be retained in younger patients such as this case. Corrective osteotomy was not performed because of the risk of necrosis. Some reports describe that the reconstruction of rotator cuff function is important in the treatment of the proximal humerus fracture and its malunion. We also believe that successful reconstruction of rotator cuff produced a good outcome.
