Three months ago, a 73-year-old woman fell down, and received conservative treatment for a valgus impacted fracture of the proximal humerus at an orthopaedic clinic. She visited our clinic complaining of severe limitation of ROM in her shoulder and residual pain at night that interfered with sleep. The patient suffered from a mental disorder, insomnia and was getting medication from a psychologist. At first examination the ROM was 70 degrees in elevation, in external rotation 10 degrees and Th12 in internal rotation. In the X-rays, the humeral head shifted downward, leaving the greater and lesser tuberosities in a comparatively elevated position. In the MRIs, it was thought that the bone blood flow had been preserved. The cause of pain and functional disability was thought to be the results of relatively elevated greater and lesser tuberosities resulting in a bony subacromial impingment. Furthermore, the rotator cuff dysfunction make impingment worse. We performed corrective osteotomy three-and a -half months after the initial accident. With the deltopectral approach, we divided the greater and lesser tuberosities on the lateral to the bicipital groove. Both the greater and lesser tuberosities were osteotomised, lowered and re-attached to the humeral diaphysis. Discomfort during movement diminished and her night pain disappeared, although postoperative rehabilitation proved difficult due to her mental disorder and thus her ROM did not improve. A year and four months after the operation, Xrays showed avascular necrosis of the humeral head. In conclusion, we experienced one case of avascular necrosis of the head after corrective osteotomy on malunited valgus-impacted fracture of the proximal humerus. Because of the high occurrence rate of complications in the treatment of malunion of the proximal humeral fracture, appropriate treatment at an early stage is extremely important.
