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Arthroscopic reduction and internal fixation of a greater tuberosity fracture of the shoulder: a case report

2003; Elsevier BV; Volume: 12; Issue: 4 Linguagem: Inglês

10.1016/s1058-2746(02)00032-0

1532-6500

Shawn Bonsell, Don Buford,

Trauma Management and Diagnosis

Isolated greater tuberosity fractures of the shoulder are rare injuries but can be seen in conjunction with 5% to 15% of anterior shoulder dislocations. 6 Horak J. Nilsson B.E. Epidemiology of fracture of the upper end of the humerus. Clin Orthop. 1975; 112: 250-253 Crossref PubMed Scopus (212) Google Scholar , 8 Rowe C.R. Prognosis in dislocations of the shoulder. J Bone Joint Surg Am. 1956; 38: 957-977 Crossref PubMed Scopus (476) Google Scholar , 9 Weaver J.K. Skiing-related injuries to the shoulder. Clin Orthop. 1987; 216: 24-28 PubMed Google Scholar The diagnosis is usually made on radiography, but recent reports have emphasized the occult nature of this injury that can only be detected by more advanced imaging modalities. 11 Zanetti M. Weishaupt D. Jost B. Gerber C. Hodler J. MR imaging for traumatic tears of the rotator cuff high prevalence of greater tuberosity fractures and subscapularis tendon tears. AJR Am J Roentgenol. 1999; 172: 463-467 Crossref PubMed Scopus (69) Google Scholar Associated injuries include anterior/inferior labral tears (Bankart lesion) and chondral injuries, and this fracture has been reported to be pathognomonic for a tear within the rotator cuff. 7 Neer C.S. Displaced proximal humeral fractures. Part 1. Classification and evaluation. J Bone Joint Surg Am. 1970; 52: 1077-1089 Crossref PubMed Google Scholar As a result of the pull of the supraspinatus tendon, the fractured greater tuberosity can displace posteriorly, and displacement of more than 1 cm and angulation of more than 45° have been the traditional indications for operative reduction and fixation. 4 Flatow E.L. Cuomo F. Maday M.G. et al. Open reduction and internal fixation of two-part displaced fractures of greater tuberosity of the proximal part of the humerus. J Bone Joint Surg Am. 1991; 73: 1213-1218 Crossref PubMed Scopus (154) Google Scholar More recent reports indicate that 3 to 5 mm of displacement of the fracture in a young, active patient who needs full motion of the shoulder is an indication for operative treatment. 10 Williams G.R. Wong K.L. Two-part and three-part fractures open reduction and internal fixation versus closed reduction and percutaneous pinning. Orthop Clin North Am. 2000; 1: 1-21 Abstract Full Text Full Text PDF Google Scholar