Date: Wed, 19 Jun 2002 00:14:19 +0530

Subject: Ununited neck of humerus with collapse of head

Requesting opinion on management:

I present this case for opinion on management.

56 year old gentleman presented with pain right upper arm and difficulty in lifting right arm. Gives history of injury two years ago following which he was operated elsewhere.(Two surgeries, the first for fixing the fracture and second for reinserting screws which pulled out).Inability to use right upper limb ever since. History of chronic alcoholism and smoking. Examination reveals two scars in the anterior part of right shoulder. Movements at right shoulder grossly restricted with pain and minimal abnormal mobilty. X-ray and clinical picture attached.

Dr.T.I. George, Consultant Orthopaedic Surgeon,
Polytrauma, Microvascular Surgery And Hand Surgery Unit,
Metropolitan Hospital, Trichur, S.India.

Reply at: Orthopaedic Trauma Association forum

Date: Fri, 21 Jun 2002 16:41:29 -0500

From: Steven Rabin

I would remove the broken hardlware, assess for infection (and treat infection if present with irrigation/debridment), and then refix. If you have it available, Synthes makes a blade plate that would be ideal since it would provide fixed angle fixation in the head. Alternatively standard compression plating could be used. A 3.5 DCP (or LC-DC) can be bent and can also used as a blade plate. I would bone graft at the same time. (On my screen, the x-ray is pretty dark, and i can't tell the condition of the humeral head or tuberosities. The title of the e-mail says that the head is collapsed. If that is the case, the alternative would be hemiarthroplasty with careful reattachment of the tuberosities, and again assessing carefully for infection.)