Varus and Shortening of the Proximal Humerus

Neer and Horowitz in 1965 wrote that fractures of the proximal humeral epiphysis comprise 3% of all epiphyseal injuries. Considering that the proximal humeral physis contributes 80% of the longitudinal growth of the bone, it is no surprise that complications of neglected fractures include shortening, as well as potential varus deformity, and restricted shoulder movement. Kohler in 1935 provided criteria for humerus varus: (Ugwonali et al., J Pediatr Orthop 27:529–532, 2007) proximal humeral neck-shaft angle of less than 140°, a greater tuberosity elevated above the superior margin of the humeral neck, and a reduced distance between the articular surface of the humeral head and the lateral cortex of the humerus (Ellefsen et al., J Pediatr Orthop 14:479–486, 1994). This deformity causes limitation in active abduction and forward flexion. The shortening is also cosmetically unsightly and may cause limitations in function. A number of techniques have been used to correct this kind of deformity, including a valgus osteotomy and fixation using tension band wiring, plates, and the Taylor Spatial Frame (Malot et al., Acta Orthop 84:280–285, 2013; Lucas and Gill, J Bone Joint Surg Am 29:367–369, 1947). We present a case of a patient with varus and shortening of the humerus corrected using an external fixator.