Pseudarthrosis of the surgical neck of humerus treated by buttressing with a medial cortico-cancellous graft

Abstract

Background: Pseudarthrosis of surgical neck of humerus is uncommon condition. Different methods of improving the stability of fixation have been described, including impaling the shaft into the head, placing a tension suture through the rotator cuff, or using an intramedullary cortical graft. We report our results of cortico-cancellous strut graft medially to counter the varus force, in conjunction with a fixed-angle implant on the lateral side.

Materials and methods: We used this technique in seven cases of pseudarthrosis of surgical neck of the humerus. There were four women and three men, ranging in age from 22 to 65 years. All were treated with a tricortical medial buttress bone graft and fixed-angle fixation device on the lateral side. A locking proximal humerus plate (Synthes) was used in six cases, and a bent reconstruction plate (Synthes) was applied in one case. The one in which reconstruction plate was applied was operated before the advent of locking plates. The limb was immobilized in 30° of abduction over a cushion for 6 weeks, followed by a sling for another 6 weeks.

Results: The followup varied from 18 to 96 months. All our cases healed within mean 5.1 months (range 4-6 months). There was one case of avascular necrosis. All cases had useful function of shoulder.

Conclusion: The medial buttressing by strut graft with external fixation by laterally placed fixed angle plate is successful to achieve fracture union in pseudarthrosis of surgical neck of humerus.

Keywords: Pseudarthrosis; bone graft; medial buttressing; surgical neck humerus.

Figure 1

X-rays of shoulder joint with proximal humerus (a) anteroposterior view (b) lateral view showing cavitation effect of long standing pseudarthrosis of fracture of surgical neck of humerus

Figure 2

X-ray shoulder joint with arm (anteroposterior view) showing strut graft held with two long screws

Figure 3

(a) Preoperative X-rays of shoulder joint (Anteroposterior view) with arm showing nonunion of the surgical neck, (b) postoperative anteroposterior X-ray shows fracture union, (c and d) clinical photographs showing shoulder functions

Figure 4

(a) X-ray shoulder joint (case no. 5) anteroposterior view shows fracture union with avascular necrosis of head of the humerus, (b) clinical photograph of same patient showing good function despite AVN of the head of the humerus