Isolated tuberosity fractures of the proximal humerus: Current concepts

Gruson, Konrad I.; Ruchelsman, David E.; Tejwani, Nirmal C.

doi:10.1016/j.injury.2007.09.022

Cited by 137 publications

(149 citation statements)

References 57 publications

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“…Platzer et al [25], in a comparative study, recommended that greater tuberosity fractures with displacement greater than 5 mm be treated operatively. The results of ORIF described previously are favorable [9,12]. However, because of the biomechanical advantage of double-row suture anchor fixation [31], this technique has been used in open and arthroscopic fixation of greater tuberosity fractures to restore the bone-tendon transition area accurately [3,17,19,22,27,28].…”

Section: Discussionmentioning

confidence: 98%

See 1 more Smart Citation

Is Arthroscopic Technique Superior to Open Reduction Internal Fixation in the Treatment of Isolated Displaced Greater Tuberosity Fractures?

Liao¹,

Zhang²,

Li³

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Arthroscopic double-row suture-anchor fixation and open reduction and internal fixation (ORIF) are used to treat displaced greater tuberosity fractures, but there are few data that can help guide the surgeon in choosing between these approaches. Questions/Purposes We therefore asked: (1) Is there a difference in surgical time between arthroscopic doublerow suture anchor fixation and ORIF for isolated displaced greater tuberosity fractures? (2) Are there differences in the postoperative ROM and functional scores between arthroscopic double-row suture anchor fixation and ORIF for isolated displaced greater tuberosity fractures? (3) Are there differences in complications resulting in additional operations between the two approaches?Methods Between 2006 and 2012, we treated 79 patients surgically for displaced greater tuberosity fractures. Of those, 32 (41%) were considered eligible for our study based on inclusion criteria for isolated displaced greater tuberosity fractures with a displacement of at least 5 mm but less than 2 cm. During that time, we generally treated patients with displaced greater tuberosity fractures with a displacement greater than 1 cm or with a fragment size greater than 393 cm with open treatment, and patients with displaced greater tuberosity fractures with a displacement less than 1 cm or with a fragment size less than 393 cm with arthroscopic treatment. Fifty-three underwent open treatment based on those indications, and 26 underwent arthroscopic treatment, of whom 17 (32%) and 15 (58%) were available for followup at a mean of 34 months (range, 24-28 months). All patients with such fractures identified from our institutional database were treated by these two approaches and no other methods were used. Surgical time was defined as the time from initiation of the incision to the time when suture of the incision was finished, and was determined by an observer with a stopwatch. Patients were followed up in the outpatient department at 6, 12, and 24 weeks, and every 6 month thereafter. Radiographs showed optimal reduction immediately after surgery and at every followup. Radiographs were obtained to assess fracture healing. Patients were followed up for a mean of 34 months (range, 24-48 months). At the last followup, ROM, VAS score, and American Shoulder and Elbow Surgeons (ASES) score were used to evaluate clinical outcomes. All these data were retrieved from our institutional database through chart review. Complications were assessed through chart review by one observer other than the operating surgeon.

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Section: Discussionmentioning

confidence: 98%

“…Previously, most greater tuberosity fractures were treated conservatively, which often led to shoulder dysfunction in patients with displaced greater tuberosity fractures [12,25]. Platzer et al [25], in a comparative study, recommended that greater tuberosity fractures with displacement greater than 5 mm be treated operatively.…”

Section: Discussionmentioning

confidence: 99%

Is Arthroscopic Technique Superior to Open Reduction Internal Fixation in the Treatment of Isolated Displaced Greater Tuberosity Fractures?

Liao¹,

Zhang²,

Li³

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…The amount and direction of displacement that benefit from surgery in isolated greater tuberosity fractures are debatable [11,13,18]. Some surgeons advocate surgical treatment for as little as 3-mm displacement, but 5 mm is a more-commonly used threshold for recommending surgery [11,21].…”

Section: Introductionmentioning

confidence: 99%

“…However, it is unclear if displacement can be assessed with this degree of precision and reliability. Some surgeons recommend CT when radiographic assessment of a greater tuberosity fracture is inconclusive [11,13].…”

Section: Introductionmentioning

confidence: 99%

Greater Tuberosity Fractures: Does Fracture Assessment and Treatment Recommendation Vary Based on Imaging Modality?

Janssen

Hermanussen

Guitton

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background For greater tuberosity fractures, 5-mm displacement is a commonly used threshold for recommending surgery; however, it is unclear if displacement can be assessed with this degree of precision and reliability using plain radiographs. It also is unclear if CT images provide additional information that might change decision making. Question/Purposes We asked: (1) Does interobserver agreement for assessment of the amount and direction of fracture-fragment displacement vary based on imaging modality (radiographs only; 2-dimensional [2-D] CT images and radiographs; and 3-dimensional [3-D] and 2-D CT images and radiographs)? (2) Does the likelihood of recommending surgery vary based on imaging modality? (3) Does the level of confidence regarding the decision for treatment vary based on imaging modality? Methods We invited 791 orthopaedic surgeons to complete a survey on greater tuberosity fractures. One hundred eighty (23%) responded and were randomized on a 1:1:1 basis in one of the three imaging modality groups and evaluated the same set of 22 fractures. We described age, sex, mechanism of injury, days between injury and imaging, and that patients had no comorbidities or signs of neurovascular damage for every case. One hundred sixty-four of the 180 respondents completed the study and there was an imbalance in noncompletion between the three groups (two of 67 [3.0%] in the radiograph only group; nine of 57 [16%] in the 2-D CT and radiograph group; and five of 56 [8.9%] in the 3-D CT, 2-D CT, and radiograph group; p = 0.043 by Fisher's exact test). Participants assessed amount (in millimeters) and direction (posterosuperior/posteroinferior/ anterosuperior/anteroinferior/no displacement) of displacement; recommended treatment (surgical or nonoperative); and indicated their level of confidence regarding the recommended treatment on a scale from 0 to 10 for every case. Overall recommendation for treatment was expressed as a surgery score per surgeon by dividing the amount of cases they would operate on by the total number of cases (n = 22) and presented as a percentage. Confidence regarding the One of the authors (DR) certifies that he, or a member of his immediate family, has or may receive payments or benefits, during the study period, an amount less than USD 10,000 from Wright Medical (Memphis, TN, USA); an amount less than USD 10,000 from Skeletal Dynamics (Miami, FL, USA); an amount less than USD 10,000 from Biomet (Warsaw, IN, USA); an amount less than USD 10,000 from AO North America (Paoli, PA, USA); and an amount less than USD 10,000 from AO International (Dubendorf, Switzerland). One of the authors (HHH) certifies that he, or a member of his immediate family, has or may receive payments or benefits, during the study period, an amount less than USD 10,000 from the Anna Foundation (The Netherlands); an amount less than USD 10,000 from the Marco Polo Fund (The Netherlands); and an amount less than USD 10,000 from the Groningen University Fund (The Netherlands). All ICMJE Conflict of Interest...

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“…Fracture of the lesser tuberosity of the humerus often occurs concurrently with fracture of the proximal humerus or dislocation of the posterior shoulder joint [1,2]. Isolated fractures of the lesser tuberosity of the humerus are extremely rare, occurring in only 0.46 persons per 100,000 [2].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2011

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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.

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Isolated tuberosity fractures of the proximal humerus: Current concepts

Cited by 137 publications

References 57 publications

Is Arthroscopic Technique Superior to Open Reduction Internal Fixation in the Treatment of Isolated Displaced Greater Tuberosity Fractures?

Is Arthroscopic Technique Superior to Open Reduction Internal Fixation in the Treatment of Isolated Displaced Greater Tuberosity Fractures?

Greater Tuberosity Fractures: Does Fracture Assessment and Treatment Recommendation Vary Based on Imaging Modality?

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

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