J Korean Fract Soc.  2016 Jan;29(1):73-78. 10.12671/jkfs.2016.29.1.73.

Functional Recovery of the Shoulder after Correcting Malrotation of the Distal Humerus: A Case Report

• Yoo H
• Han J
• Byun Y
• Jeong D
• Shin D

• KMID: 2183769
• DOI: http://doi.org/10.12671/jkfs.2016.29.1.73

Abstract

Although studies on malrotation of the humerus possibly leading to dysfunction of the shoulder have been reported, studies on its causes are inadequate. The authors encountered a patient complaining of malrotation accompanied by dysfunction of the shoulder which occurred during treatment of a distal humeral fracture. The patient recovered the shoulder function by only correcting malrotation of the humerus without direct treatment on the shoulder, and we report it herein with a review of the literature.

Keyword

Humerus; Fracture; Rotational deformity; Malunion; Malrotation; Shoulder function

MeSH Terms

Humans
Humeral Fractures
Humerus*
Shoulder*

Figure

• 

  Fig. 1 (A) Initial radiographs show a comminuted open fracture of the distal humerus. (B) Radiographs after the emergency operation show open reduction and internal fixation with a long anatomical plate on the anterior aspect of the medial column and a short reconstruction plate on the lateral column.

• 

  Fig. 2 Radiograph 7 months after the initial operation shows non-union of the distal humeral fracture with loss of reduction.

• 

  Fig. 3 Photographs 7 months after the initial operation show the limitation of the right shoulder motion.

• 

  Fig. 4 Bilateral anteroposterial radiographs (A) and bilateral (B) computed tomography scans show 45° of malrotation of the right humerus.

• 

  Fig. 5 Intraoperative photographs show 45° of derotation with 2 K-wires.

• 

  Fig. 6 Final radiographs 17 months after the operation show solid union without implant loosening and loss of reduction.

• 

  Fig. 7 Photographs 2 years after the operation show a good functional result of the right shoulder.

Reference

1. Puloski S, Romano C, Buckley R, Powell J. Rotational malalignment of the tibia following reamed intramedullary nail fixation. J Orthop Trauma. 2004; 18:397–402.

2. Buckley R, Mohanty K, Malish D. Lower limb malrotation following MIPO technique of distal femoral and proximal tibial fractures. Injury. 2011; 42:194–199.

3. Wallny T, Sagebiel C, Westerman K, Wagner UA, Reimer M. Comparative results of bracing and interlocking nailing in the treatment of humeral shaft fractures. Int Orthop. 1997; 21:374–379.

4. Flury MP, Goldhahn J, Holzmann P, Simmen BR. Does Weber's rotation osteotomy induce degenerative joint disease at the shoulder in the long term? J Shoulder Elbow Surg. 2007; 16:735–741.

5. Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res. 1987; (214):160–164.

6. Boileau P, Bicknell RT, Mazzoleni N, Walch G, Urien JP. CT scan method accurately assesses humeral head retroversion. Clin Orthop Relat Res. 2008; 466:661–669.

7. Li Y, Wang C, Wang M, Huang L, Huang Q. Postoperative malrotation of humeral shaft fracture after plating compared with intramedullary nailing. J Shoulder Elbow Surg. 2011; 20:947–954.

8. Robinson CM, Bell KM, Court-Brown CM, McQueen MM. Locked nailing of humeral shaft fractures Experience in Edinburgh over a two-year period. J Bone Joint Surg Br. 1992; 74:558–562.