Abstract:Two cases of acute isolated avulsion fracture of the lesser tuberosity of the humerus and their short-term outcome are presented with a review of previously reported cases. Open reduction and internal fixation was performed. Outcomes were excellent, and the patients regained their normal pain-free shoulder function 3 months after the operation. This was a Level IV study.
“…A surgical treatment is mandatory in case of dislocation, but if not then conservative treatment shows similar results in previous reviews of the literature [8][9][10][11] . The patient commenced on rehabilitation immediately without previous period of immobilisation of the upper limb, a sling was used upon diagnosis and for the first 2 weeks to support the arm and oral pain medication was prescribed as well.…”
Section: Jrpmsmentioning
confidence: 54%
“…The main mechanism of the injury is the forceful contraction of the subscapularis usually after a fall as in our patient. It involves a high energy transfer in most of the cases reported 3,10 . The subscapularis muscle restricts rapidly and with great force and results in the avulsion of the lesser tuberosity.…”
“…A surgical treatment is mandatory in case of dislocation, but if not then conservative treatment shows similar results in previous reviews of the literature [8][9][10][11] . The patient commenced on rehabilitation immediately without previous period of immobilisation of the upper limb, a sling was used upon diagnosis and for the first 2 weeks to support the arm and oral pain medication was prescribed as well.…”
Section: Jrpmsmentioning
confidence: 54%
“…The main mechanism of the injury is the forceful contraction of the subscapularis usually after a fall as in our patient. It involves a high energy transfer in most of the cases reported 3,10 . The subscapularis muscle restricts rapidly and with great force and results in the avulsion of the lesser tuberosity.…”
“…While large fragments may be visible on standard anteroposterior imaging, anteroposterior imaging with maximal internal rotation or an axillary view is critical for detecting smaller fragments with minimal displacement ( Fig 8 A). 35 Advanced imaging with either computed tomography or magnetic resonance imaging can also be beneficial, as in the case detailed above ( Fig 8 B). Fig 8 (A) Axillary view radiograph of a left shoulder demonstrating an avulsion fracture (arrow) of the lesser tuberosity.…”
Although some literature may suggest that acute nondisplaced lesser tuberosity fractures should undergo nonoperative management, there is a body of evidence that supports surgical stabilization of these injuries due to concern for fracture displacement, nonunion and malunion, anteromedial impingement, and possible biceps tendon subluxation or dislocation. In this Technical Note, we introduce a novel technique for arthroscopic fixation of lesser tuberosity avulsion fractures using a knotless repair. In the lateral decubitus position using standard arthroscopic portals, with the addition of the biceps accessory portal, 2 ULTRATAPE sutures are fixed to the avulsed fragment in luggage-tag fashion to create a secure, knotless fixation. These are used to mobilize and anatomically approximate the lesser tuberosity to the avulsion bed and are held in place with suture anchors placed immediately adjacent to the fracture bed. This technique provides good anatomic reduction with maximal surface area for bone-to-bone healing.
“…36,41 Displaced fractures are best managed with screws or sutures and anchors; the former is preferred if the fragment is large enough, including headless screws. 37,38,40,41,91 Cerclage wiring has also been used for lesser tuberosity injuries. 36 Nonsurgical therapy can lead to chronic shoulder pain, particularly if not well reduced.…”
Section: Treatment Of Avulsion Fracturesmentioning
confidence: 99%
“…36,38 Computed tomography will be helpful for a more accurate assessment of the fracture. 36,38,40,41 Injuries to the coracoid process represent 3% to 13% of all scapular fractures, a proportion of which are due to avulsion. 42,43 This injury will limit shoulder abduction and flexion.…”
Avulsion fractures compromise function and movement at the affected joint. If
left untreated, it can lead to deformity, nonunion, malunion, pain, and
disability. The purpose of this review was to identify and describe the
epidemiology and available treatment options for common avulsion fractures of
the upper and lower extremities. Current evidence suggests that optimal
treatment is dependent on the severity of the fracture. Conservative efforts
generally include casting or splinting with a period of immobilization. Surgery
is typically indicated for more severe cases or if nonoperative treatments fail;
patient demographics or preferences and surgeon experience may also play a role
in decision making. Some avulsion fractures can be surgically managed with any
one of various techniques, each with their own pros and cons, and often there is
no clear consensus on choosing one technique over another; however, there is
some research suggesting that screw fixation, when possible, may offer the best
stability and compression at the fracture site and earlier mobilization and
return to function. Physicians should be mindful of the potential complications
associated with each intervention.
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