Improved range of motion following correction osteotomy for varus malunited proximal humerus fractures with 3-dimensional planned cutting guides: a case series
Year: 2026
Type: article
Abstract: Background Varus malunion of the proximal humerus can lead to persistent pain and restricted shoulder mobility. When symptoms persist despite conservative treatment, valgus wedge osteotomy may be considered. This case series reports the outcomes of corrective osteotomy for varus malunion of two-part proximal humerus fractures using patient-specific three-dimensional (3D) cutting guides, fixed with a PHILOS plate (Synthes®) in patients younger than 65 years. We hypothesized that this technique would improve forward flexion, restoring at least 80% of the forward flexion of the contralateral, unaffected shoulder. Methods All patients in this study were referred to our clinic for further treatment and had received at least six months of physiotherapy prior to this. The patients were dissatisfied with their shoulder after conservative treatment, for most primarily due to the limited elevation. Patients were eligible if they were younger than 65 years, had closed epiphyses, and presented with an untreated varus malunion of the proximal humerus. Exclusion criteria included frozen shoulder, signs of rotator cuff tear, or neurologic abnormalities. The primary outcome measure was the difference in forward flexion, assessed by a single observer using a goniometer preoperatively and at a minimum of 1-year follow-up. Secondary outcomes included the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score, the Oxford Shoulder Score, visual analog scale (VAS) scores for pain and satisfaction, correction of the head–shaft angle, and complications. Results Eleven patients underwent 3D planned corrective osteotomy. At 1-year follow-up, median forward flexion improved from 100° to 148°, corresponding to 94% of the contralateral side ( p = 0.005), and median abduction improved from 80° to 145° ( p = 0.005). Patient-reported outcomes improved significantly, with the median Oxford Shoulder Score decreasing from 25 to 17 ( p = 0.01), the median QuickDASH score from 34 to 13 ( p = 0.02), and median VAS satisfaction increasing from 3 to 9 ( p = 0.02). The median humeral head–shaft angle increased from 95° preoperatively to 121° postoperatively ( p = 0.003). Three major complications (low-grade infection, hardware breakout, and frozen shoulder) and one minor complication (hypertrophic scarring) were observed. Seven patients (64%) experienced hardware irritation requiring removal. Conclusions In this case series, 3D planned corrective osteotomy for varus malunited proximal humerus fractures resulted in clinically relevant improvements in forward flexion and overall shoulder ROM. Postoperative anterior flexion was better than the presumed 80% of the contralateral side in most patients. These findings suggest that patient-specific 3D planning may be a valuable adjunct in the correction of proximal humerus malunions.
Source: JSES International
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $1,250
OpenAlex ID: W7212251747