Isolated Fracture of the Lesser Tuberosity of the Humerus: A Case Report

Abstract

Summary:Fracture of the lesser tuberosity of the humerus often occurs concomitant with posterior shoulder dislocation or proximal humeral fracture, while isolated fractures are extremely rare. We report a case in which an isolated fracture of the lesser tuberosity of the humerus occurred due to a distinctive pathogenic mechanism. A 43-year-old male had his right shoulder forced into internal-rotation (i.e. back reach position) when he fell into a ditch approximately 70 cm wide and 1.5 m deep. Subcutaneous bleeding and tenderness were detected anteriorly in the shoulder, with restricted range of motion. Radiographs indicated a fracture of the lesser tuberosity of the humerus. Three-dimensional computed tomography (CT) confirmed an isolated fracture of the lesser tuberosity, which was displaced anteromedially by more than 5 mm from its previous anatomical position. During operation, the fractured fragment of the lesser tuberosity was reduced easily and fixed by a cancellous bone screw. At postoperative 2 years, the patient has recovered full range of motion with sufficient muscle strength, and has returned to work. The pathogenic mechanisms in this case were unique, differing from those that have been previously reported.

Isolated Fracture of the Lesser Tuberosity, A Case Report and Literature Review

“…In acute and chronic cases, patients report anterior shoulder pain and a reduced range of motion about the shoulder [2,4,11,12,14,15,[17][18][19][20][21][22]24,25,27,31,32,34,[36][37][38][39][40].…”

“…Other examination findings include severe pain with passive external rotation [12,14,36], weakness of internal rotation [2,11,19,20,[21][22][23][25][26][27][28][29]31,32,40] and positive apprehension and relocation tests [2,4,40]. These findings are not specific to the diagnosis of lesser tuberosity avulsion.…”

Characteristics of patients who fell into open drains: a report from a single emergency center in East Shizuoka

“…We summarize the published Japanese case reports, describing the injuries suffered by patients due to falls into open drains, in Table , excluding Nosaka's report . Table reveals the various types of injuries and their severity.…”

“…Accidental falls into open drains are a constant occurrence in rural areas. There are previous case reports in Japan that have described the various injuries caused by falls into open drains; however, few reports have investigated the characteristics of injuries caused by such falls . Accordingly, we carried out a retrospective study in our institute on the nature of the injuries caused by falls into open drains in East Shizuoka, Japan.…”

Nonunion of Lesser Tuberosity Fracture in A 16 Years Old Teenager

“…After a thorough review of the world literature (PubMed, Embase, Cochrane), we found n re-ported cases of delayed diagnosis or treatment of this injury (Neogi et al, 2013;Vezeridis et al, 2011) and n reported cases of acute isolated fractures of the lesser tuberosity (Teixeira et al, 2012;Tosun and Kesemenli, 2011;Ohzono et al, 2012;Provance AJ and Polousky, 2010;Dhawan et al, 2008;Hepp et al, 2008;Gruson et al, 2008;Alistair Pace, 2008;Levine et al, 2005;Hinov et al, 2002;Kanso and Bricout, 1998;Ogawa and Takahashi, 1997;Caniggia et al, 1996;Van Laarhoven et al, 1995;Paschal et al, 1995;Le Huec et al, 1994;Kuroda et al, 1993;Kunkel and Monesmith, 1993;Earwaker et al, 1990;. However we could not find any report of nonunion of an avulsed lesser tuberosity not related to posterior shoulder dislocation.…”