Valgus Osteotomy of the Humerus Neck for the Treatment of Humerus Varus

Abstract

A 2lyear old male has complained of right shoulder pain while pitching since he was 14 years old. He first noticed a discrepancy of the length of his right upper arm during junior high and the discrepancy aggravated according to his growth during his high school years. He had mild pain in the right shoulder, however, he was still able to continue to play baseball as a hobby. As he continued throwing, the pain progressed with limited abduction. He began avoiding weight-bearing on his right arm and arm raising became a difficulty. For these reasons, he was referred to our clinic with a humerus varus. On physical examination, there was a 4.5cm of arm length discrepancy. Active forward flexion was 120 ° and abduction was 90 °. Radiographs demonstrated a growth arrest of the proximal humerus with a 65 ° neck-shaft angle. An open wedge osteotomy of the humeral neck was performed. Adhesion between the deltoid and the proximal humerus was observed. Scarring of the soft tissue surrounding the medial proximal humerus and was also evident. The denseness of the surgical neck of the humerus was recognized. The neck-shaft angle improved from 65 ° before surgery to 138 ° after surgery. Valgus osteotomy of the humeral neck allowed an improved function of the arm with an increase in active abduction and forward flexion.