Humeral Osteotomies

Indications

1. Post-traumatic Malunion

• Angular deformity

• Rotational deformity

• Shortening

2. Deformity Correction

• Cubitus varus / valgus

• Rotational abnormalities

3. Shoulder Pathology

• Excessive retroversion / anteversion

• Instability cases

4. Elbow Dysfunction

• Malalignment affecting ROM

• Functional limitation

Principles

• Restore:

  • Mechanical axis

  • Joint orientation

  • Rotational alignment

Multiplanar deformities are common

Types of Osteotomies

1. Closing Wedge Osteotomy

• Bone wedge removed

Advantages:

• Stable

• Simple

Disadvantages:

• Limb shortening

2. Opening Wedge Osteotomy

• Gap created and filled (graft)

Advantages:

• Maintains length

Disadvantages:

• Requires graft

• Less stable

3. Dome Osteotomy

• Curved cut

Advantages:

• Multiplanar correction

• Smooth alignment

Disadvantages:

• Technically demanding

4. Step-Cut Osteotomy

• Interlocking geometry

Advantages:

• Rotational control

• Stability

5. Derotational Osteotomy

• Corrects rotational deformity

Common in:

• Humeral retroversion abnormalities

Location-Based Approach

Proximal Humerus

• Used for: Version correction / Instability

Humeral Shaft

• Used for: Rotational deformity / Malunion

Distal Humerus

• Used for: Cubitus varus / valgus

• Most common in pediatrics

Fixation Methods

• Plate and screws (standard)

• Intramedullary nail (selected cases)

• K-wires (pediatric)

Preoperative Planning (Critical)

• Identify:

  • Plane of deformity

  • Magnitude

  • Rotation

Consider:

• 3D planning / patient-specific guides

Postoperative Management

• Early motion if stable fixation

• Physiotherapy

• Monitor neurovascular status

Complications

• Nonunion

• Malunion

• Nerve injury (radial nerve!)

• Loss of correction

• Infection

Prognosis

• Good with accurate planning

• Functional improvement depends on:

  • Joint involvement

  • Chronicity

Pits & Pearls

• Rotation matters more than angle in many cases

• Always identify deformity plane

• Stable fixation = early motion

• Radial nerve is at risk

Pitfalls

• Ignoring rotational deformity

• Inadequate planning

• Poor fixation

• Overcorrection

Mini Decision Algorithm