Journal of Musculoskeletal Trauma

Conservative Treatment of Valgus Impacted Four-Part Fracture of the Proximal Humerus: A Case Report: Moon Chan Kim, Jae Lim Cho, Hung Tae Chung, Dong Jun Kim, In Bo Kim; J Korean Fract Soc 2011;24(1):96-99. Published online January 31, 2011; DOI: https://doi.org/10.12671/jkfs.2011.24.1.96

Abstract PDF: For valgus impacted four part fracture of the proximal humerus, surgical stabilization and early mobilization of the joint can produce the best clinical outcomes. But, we have experienced a case of conservative treatment and gained good clinical results. We have reported this case and included a review of the relevant literatures.

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Comparison study between valgus and varus type in Neer 's 3 and 4 part proximal humerus fracture: Chang Hyuk Choi, Koing Woo Kwon, Shin Kun Kim, Sang Wook Lee, Dong Kyu Shin, Seung Jin Lee; J Korean Soc Fract 2002;15(4):558-565. Published online October 31, 2002; DOI: https://doi.org/10.12671/jksf.2002.15.4.558

Abstract PDF: PURPOSE
We reclassified three- and four-part proximal humerus fractures by Neer ' s classification into valgus & varus type, and compared the results of these groups. MATERIALS & METHODS: 21 cases classified as three- and four-part fracture in Neer 's classification were treated surgically and followed for 12 months. We reclassfied the 21cases valgus and varus type fractures, according to angulation of fractures, facing of humeral head, and dominant displaced tuberosity. Functional evaluation was done by UCLA shoulder rating scale.
RESULTS
Neer 's three- and four-part proximal humerus fractures could be reclassified based on angulation, facing of humeral head, and dominant tuberosity displacement. The functional results according to UCLA shoulder rating scale were good or excellant in 8 of 9 cases of valgus type(89%), and at 4 in 10 cases of varus type(40%). The clinical result of the valgus type was better than that of the varus type.
CONCLUSION
Based on reclassification system of proximal humerus fractures, clinical results and radiographic findings including angulation, facing of head, and dominant tuberosity displacement showed close relationship. Neurovascular complication were more frequent in the varus type. Therefore, careful evaluation including surgical approach and soft tissue status should be considered in the varus type of complex proximal humerus fracture.

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Impacted Cancellous Allograft and Valgus Fixation of Intertrochanteric Fracture Nonunion: Soon Yong Kwon, Young Kyun Woo, Jong Min Sohn, Jin Hwa Chung, Jung Ho Lee, Yong Sik Kim; J Korean Soc Fract 2002;15(1):65-71. Published online January 31, 2002; DOI: https://doi.org/10.12671/jksf.2002.15.1.65

Abstract PDF: PURPOSE
The aim of this study was attempted to evaluate the effects of impacted cancellous allograft and valgus fixation in the management of nonunion of intertrochanteric fracture of the femur.
MATERIALS AND METHODS
Between June 1995 and October 1999, 5 patients, ranging from 38 to 75 years of age, with nonunion of femoral intertrochanteric fracture, whose primary treatment had been done with compression hip screws, were treated with impacted cancellous allograft and valgus fixation RESULTS: After follow-up from 13 months to 24 months, among the 5 cases, 4 cases resulted in the union in a mean time of 16 weeks, improvement of LLD in a mean length of 0.8cm and good function of abduction, but 1 case resulted in nonunion, followed by total hip arthroplasty.
CONCLUSION
For patients with nonunion of femoral intertrochanteric fracture, impacted cancellous allograft and valgus fixation provide a good result of union.

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Supracondylar Osteotomy in Cubitus Valgus by Posterior Approach and Internal Fixation with Y-plate: Eun Sun Moon, Jae Hyung Park, Hyoung Yeon Seo; J Korean Soc Fract 1997;10(4):912-917. Published online October 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.4.912

Abstract PDF: Cubitus valgus may arise as the sequele of a number of different condition for example, a premature epiphysiodesis of the lateral condylar physis, nonunion or malunion of the lateral condylar fracture, rarely supracondylar fracture of the humerus. Cubitus valgus has more functional loss of extension and possibly the late development of a tardy ulnar nerve paralysis and less significant cosmetic effect. Authors treated the 7 patients who had cubitus valgus developing as a sequele of nonunion of the lateral condyle of the humerus, by the medial closed wedge osteotomy and internal fixation with the lateral arm cut anatomical Y-plate through posterior approach. Five males and two females were followed average 19 months(range 5 to 37 months). A mean age at the time of the operation was 17.1 years(range 13 to 25 years). Symptoms of tardy ulnar nerve palsy was shown in 5 patients. Two patients were treated due to disappearing cosmetic problem. The carrying angle was mean valgus 31 (range 22~50) preoperatively. The carrying angle was changed from mean valgus 9.6(range 3-15) immediate postoperatively to valgus 9(range 3-14) followed state. The duration of external immobilization after operation was mean 4.1 weeks(range 3-5 weeks). Range of motion of the elbow was fully recovered in 6 cases. The neurologic deficit of the tardy ulnar nerve palsy was fully recovered in all five patients. The result of supracondlar osteotomy was excellent in 4 cases(57.1%), good in 2 cases(28.6%) and poor in 1 case(14.3%). In conlusion, internal fixation with the lateral arm cut anatomical Y-plate after medial closed wedge osteotomy through the posterior approach can be recommanded as a method of treatment for the cubitus valgus.

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Supracondylar Osteotomy for Cubitus Varus and Valgus: Duk Seop Shin, Jong Chul Ahn, Se Dong Kim, Yong Seok Choi; J Korean Soc Fract 1994;7(1):49-57. Published online May 31, 1994; DOI: https://doi.org/10.12671/jksf.1994.7.1.49

Abstract PDF: Between December 1989 and january 1944, 17 corrective supracondylar osteotomy of humerus for cubitus varus and valgus were performed at department of orthopaedic surgery in Yeugnam University. Supracondylar fracture was the most common cause of deformity Average age at operation was 18.6 years old and average follow up period was 14 months. The operation was done under the comprehensive preoperative plan, and Internal fixation was done with K-w,res ,n younger patients, and with plates and screws in elder ones(77%). Period for external fixation could be shortened by firm internal fixation. The result was exllent in nine cases, good in four, and poor in four. No ulna and radial nerve palsy were found in operation of cubitus varus. There were three tardy ulna nerve palsy In cubitus valgus, then anterior transposition of ulna nerve was done.

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The Supracondylar Osteotomy for the Angular Dformity followed by a Fracture Around the Elbow: Soo Ill Kang, Kang Hyung Lee, Chan Su Park, Myung Ku Kim, Myung Seon Kim; J Korean Soc Fract 1990;3(1):103-109. Published online May 31, 1990; DOI: https://doi.org/10.12671/jksf.1990.3.1.103

Abstract PDF: The fracture around the elbow is frequent in the children. The cubitus varus and cubitus valgus deformities are the common late complications of the elbow fracture. The reason of correction for these problem is not the elbow fuction, but the cosmetic problem of tardy ulnar nerve palsy. We performed five supracondylar osteotomies that are modification of Milch osteotomy from Mar, 1988 to Jan, 1989 of which four cases were cubitus varus and one case was cubitus valgus at In Chon Christian Hospital. The results were as follows; 1. the cubitus varus deformities were four cases and the cubitus balus deformity was one. 2. The injuries were supracondylar fractures of the humerus for the cubitus varus and lateral condyle fracture of the humerus for the cubitus valgus. 3. The result was excellent by modified Milch osteotomy with derotation in the case of rotational deformity. 4. In adult, the bone healing was promoted by deepening the triangular shaped notch in the Milch osteotomy by widening the contact surface.

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