Reconstruction of the valgus-impacted humeral head fracture.

Between 1985 and 1991, 22 patients (average age 52 years, range 26 to 65 years) with severely impacted humeral head fractures were operated on with the aim of preserving the humeral head. All 22 cases showed no significant lateral displacement. Thus it was assumed that the periosteum leading medially to the humeral head was intact and that the vessels passing through the periosteum would ensure survival of the humeral head segment. All patients underwent treatment with open reduction. The impacted segment of the humeral head was raised, the tuberosities were relocated, and the void was filled with chips of cancellous bone. This procedure provided fixation with minimal osteosynthesis. At follow-up evaluation (minimum 18 months, average 36 months) one patient had sequestration of the head segment, and another patient had clinically asymptomatic partial necrosis. None of the remaining 20 patients showed signs of necrosis. Slight arthrosis was present in two patients, and moderate arthrosis was present in one. A correlation was found between the functional result and the quality of reduction. Where anatomic reconstruction had been successful, the long-term functional result was almost identical with the nontraumatized side.