[Four part valgus impacted fractures of the upper extremity of humerus: ilium graft reconstruction. Apropos of 8 cases].

PURPOSE OF THE STUDY: We present the results of an original technique for reconstruction of valgus-impacted humeral head using autologous iliac bone.

MATERIAL AND METHODS: Between 1992 and 1993, 8 patients (average age 66 years, range 43 to 79 years) with four-part valgus impacted proximal humeral fractures were operated with the aim of preserving the humeral head. All fractures were treated with open reduction and were stabilized only with autologous bone. This procedure provided fixation without osteosynthesis. Using a deltopectoral approach the impacted segment of the humeral head was raised, the void was filled with autologous three-cortical iliac bone graft, and the tuberosities were relocated with the goal of anatomic reconstruction. The assessment included clinical examination including Constant's score, radiographic examination and MRI examination. Only one patient was not available for the review at follow-up evaluation (minimum 12 months, average 16 months).

RESULTS: According to Constant's criteria, two results were excellent, two very good, one good, one fair and one patient were considered failure. Average Constant's score was 62; average score in comparison with the healthy side was 76 per cent. Radiographic findings showed in all cases healing and incorporation of the graft. MRI results showed only one asymptomatic partial avascular necrosis (14 per cent).

DISCUSSION: This specific type of displaced four-part fracture of the proximal humerus which consists of valgus impaction of the head fragment without lateral displacement has a rate of avascular necrosis lower than that of other displaced four-part fractures. Blood supply of the articular segment is maintained via the periosteum extending to the medial part of the anatomic humeral neck. These data authorized the authors to propose a new conservative treatment for four-part valgus impacted proximal humeral fractures.