Operative treatment of nonunion of surgical neck fractures of the humerus.

Seventeen patients who had undergone operative treatment for painful nonunion of a surgical neck fracture of the proximal humerus were evaluated an average of 6.3 years (range, 2-11 years) from the time of surgery to determine clinical and radiographic outcome. Ten patients underwent open reduction and internal fixation with tension band wiring and Rush rods, and 7 underwent proximal humeral hemiarthroplasty. The average age of the patients was 60 years old. After surgery, pain, function, and range of motion improved for both groups. University of California Los Angeles scores improved from an average of 4.4 to 22 points in the internal fixation group and from 4.8 to 21.4 in the hemiarthroplasty group. All 17 patients were eventually able to perform activities of daily living independently. No patient in either group was able to return to his or her preinjury level of work. Nonunion persisted in 2 patients who had undergone internal fixation, and avascular necrosis developed in 2 others. Eight of 10 patients in the internal fixation group required removal of the Rush rods for treatment of symptomatic mechanical impingement. Painful nonunion of a surgical neck fracture of the proximal humerus is a difficult problem to manage operatively. Pain relief and functional improvement was similar in patients who underwent either procedure. However, 11 of 17 patients had fair or poor ultimate outcomes.