[Treatment of Neer type 4 impacted valgus fractures of the proximal humerus with open reduction, elevation, and grafting]

Abstract

Objectives: We evaluated the clinical and radiographic results of minimal invasive surgery, with elevation of the head and tricortical iliac grafting for Neer type 4 impacted valgus fractures.

Methods: Ten patients (6 females, 4 males; mean age 54 years; range 35 to 67 years) with Neer type 4 impacted valgus fractures of the proximal humerus underwent biological reconstruction including open reduction, elevation of the head fragment, grafting, and suture fixation of tuberosities. All the patients were assessed by computed tomography preoperatively. Tricortical iliac crest autograft was used in three patients and lyophilized iliac allograft was used in seven patients. The mean time to surgery was three days (range 1 to 10 days). Radiographic and clinical results were evaluated after a mean follow-up of 38.8 months (range 24 to 49 months). Constant and DASH (disabilities of the arm, shoulder and hand) scores were used for functional evaluation.

Results: All the fractures united within six to eight weeks. On final examinations, the mean forward flexion of the shoulder was 154 degrees (range 120 degrees to 175 degrees ) and external rotation was 44 degrees (35 degrees to 55 degrees ). The mean Constant and DASH scores were 81.5 (range 72 to 90) and 23 (range 17 to 38), respectively. The mean inclination angle of the humerus head decreased from 178 degrees (170 degrees -200 degrees ) to 134 degrees (130 degrees -145 degrees ) postoperatively. None of the patients had signs of osteonecrosis in the humeral head. All the patients were pleased with the outcome.

Conclusion: The biologic reconstruction technique used with graft support may be an effective alternative treatment in selected patients with type 4 valgus impacted fractures of the proximal humerus.