Surgical Treatment of Displaced Greater Tuberosity Fractures of the Humerus

Rouleau, Dominique M.; Mutch, Jennifer; Laflamme, Georges-Yves

doi:10.5435/jaaos-d-14-00289

Cited by 64 publications

(65 citation statements)

References 45 publications

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“…With appropriate clinical examination and suspicion, the advanced practice provider should obtained advanced imaging in the form of magnetic resonance imaging or computed tomography ( Fahmy et al, 2011 ;Gumina et al, 2009 ). Attention should be given to any amount of displacement, understanding that a moderately displaced fracture (defi ned as ≥ 5 mm of displacement) is better treated surgically ( Platzer et al, 2008 ;Rouleau et al, 2016 ). As highlighted here, those patients with a nondisplaced or minimally displaced fracture can be treated conservatively ( Mattyasovszky et al, 2011 ;Rath et al, 2013 ).…”

Section: Discussionmentioning

confidence: 96%

“…Although plain radiographs are usually adequate for identifying this pathology, there is potential for a nondisplaced fracture to be missed ( Gumina et al, 2009 ;Mattyasovszky et al, 2011 ;Rouleau et al, 2016 ). With appropriate clinical examination and suspicion, the advanced practice provider should obtained advanced imaging in the form of magnetic resonance imaging or computed tomography ( Fahmy et al, 2011 ;Gumina et al, 2009 ).…”

Section: Discussionmentioning

confidence: 99%

“…In cases in which radiographic fi ndings are not evident, the advanced practice provider needs to consider advanced imaging of the shoulder to assess for an occult fracture or other underlying process such as a rotator cuff tear ( Fahmy, Antonakopoulos, & Khan, 2011 ;Mattyasovszky et al, 2011 ). Nondisplaced, as well as minimally displaced ( < 5-mm displacement), fractures can be treated successfully with conservative management ( Fahmy et al, 2011 ;Mattyasovszky et al, 2011 ;Rouleau, Mutch, & Lafl amme, 2016 ). Here is presented a case, with associated imaging fi ndings, of an isolated nondisplaced greater tuberosity fracture of the humerus.…”

Section: Introductionmentioning

confidence: 88%

“…Conservative management was the recommended approach for the fi nding of nondisplaced greater tuberosity fracture and associated rotator cuff pathology ( George, 2007 ;Mattyasovszky et al, 2011 ;Rath et al, 2013 ;Rouleau et al, 2016 ). The patient was provided a…”

Section: Managementmentioning

confidence: 99%

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Greater Tuberosity Fracture of the Humerus

Patrick

2016

Orthopaedic Nursing

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F IGURE 2. Coronal and axial T2-weighted magnetic resonance images of nondisplaced greater tuberosity fracture. Note surrounding bony edema. Fracture fragment is circled.sling for stabilization and comfort. Tramadol and naproxen were the medications used for pain management. She was instructed on activity restrictions. After the third week, she was instructed on activities to improve range of motion including pendulum and wall crawl exercises. Close follow-up, at 2-week intervals, was undertaken and repeat radiographs showed no displacement of fracture fragment with adequate healing and alignment (see Figure 3 ).After evaluation at the 6-week follow-up, the patient was referred to physical therapy for formal stretching, range of motion, and rotator cuff strengthening F IGURE 1. Initial radiographs of right shoulder taken on the day of fall. These images were read in the emergency department as "normal." In retrospect, one can appreciate the subtle cortical disruption consistent with a nondisplaced greater tuberosity fracture. F IGURE 3. Six-week follow-up images showing stability/no displacement of greater tuberosity fracture, appropriate healing, and alignment. exercises. As discussed by Rath et al. (2013) , a staged rehabilitation protocol is typically adequate in achieving favorable outcomes.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 88%

Section: Managementmentioning

confidence: 99%

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Greater Tuberosity Fracture of the Humerus

Patrick

2016

Orthopaedic Nursing

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“…Park TS recommended that GT fractures with a displacement greater than 5 mm should be treated operatively [16]. On the other hand, Rath E had shown that conservative treatment with a displacement of less than 3 mm could achieve clinical results [17][18]. In our study, isolated GT fracture, J.Mutch type, was employed to be our diagnosis.…”

Section: Complicationsmentioning

confidence: 90%

Operative Treatment of Isolated Split Greater Tuberosity Fracture (mutch type II) of Proximal Humerus with Modified PHILOS

Liu¹,

Zhang²,

Guo³

et al. 2020

Preprint

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Background: The greater tuberosity (GT) of the proximal humerus is the attachment point of the rotator cuff, which plays a role in the movement of the shoulder joint and is the core of the entire shoulder joint. Material and Methods: In our current study, 40 patients with isolated split GT fracture (mutch type II) from july 2017 to January 2019, which was typed by J.Mutch professor, Canada in 2014, were employed in the study. They were divided into two groups: the Modified PHILOS plate group (group A, n=20) and the Hollow Screw group (group B, n=20). The functional scores Constant‑Murley Score (CMS), American Shoulder and Elbow Surgeons (ASES), The University of California at Los Angeles shoulder rating scale (UCLA) and Visual Analogue Score (VAS) were recorded in both pre-op and post-op last follow. Results: Compared with last-follow, all shoulder scores (CMS, ASES, and UCLA) of group A was significantly better than group B (P<0.05), but VAS (P>0.05). Moreover, in post-op complications, there were one GT malunion and one shoulder pain in group A, but in group B, there were seven GT disappear (35%), three GT malunion and two patients with repeated shoulder pain. Conclusion: The Modified PHILOS plate in treating isolated split GT fracture (mutch type II) was found to be effective than hollow screw in the short term follow. However, there are still some post-op complications in both groups. Keywords : Isolated Split GT Fracture; Modified PHILOS Plate; Hollow Screw

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Excellent clinical and radiological outcomes after arthroscopic reduction and double row‐suture bridge for large‐sized greater tuberosity fractures of the humerus

Ko,

Oh,

Park

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeCurrently, there is limited information on the clinical outcomes of arthroscopic reduction and double‐row suture bridge fixation for large greater tuberosity fractures of the proximal humerus. This study aimed to evaluate the radiological and clinical outcomes of arthroscopic reduction and double‐row suture bridge fixation for these fractures, hypothesizing that arthroscopic reduction and double‐row suture bridge fixation is a safe, effective and minimally invasive treatment for large greater tuberosity fractures.MethodsThis retrospective study analysed patients with large greater tuberosity fractures (fracture fragment ≥30 mm in diameter) who underwent arthroscopic reduction and double‐row suture bridge fixation and had a follow‐up period exceeding 2 years. The anatomic reduction was confirmed by assessing the step‐off on radiographs immediately after surgery, and the radiologic union time was recorded. At the final follow‐up, range of motion and functional outcome scores were evaluated. Additionally, any surgery‐related complications were evaluated.ResultsFifteen patients with a mean follow‐up of 57.7 ± 23.1 months were included in the study. The mean fracture fragment size was 32.5 ± 2.4 mm, with a mean displacement of 5.1 ± 1.6 mm. Immediately postsurgery, 13 of 15 patients (86.7%) had a fracture step‐off of <3 mm, with an average union time of 3 months. At the final follow‐up, patients demonstrated excellent outcomes, with an average forward flexion of 167 ± 9.7° and external rotation of 70 ± 16.3. Functional outcome scores showed significant improvement compared with preoperative scores (p < 0.001). No major surgery‐related complications were reported.ConclusionsArthroscopic reduction and double‐row suture bridge fixation for large‐sized greater tuberosity fractures is safe and shows good fracture reduction and excellent clinical outcomes. Therefore, this surgical method can be considered an alternative to open reduction for large greater tuberosity fractures.Level of EvidenceLevel IV.

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Surgical Treatment of Displaced Greater Tuberosity Fractures of the Humerus

Cited by 64 publications

References 45 publications

Greater Tuberosity Fracture of the Humerus

Greater Tuberosity Fracture of the Humerus

Operative Treatment of Isolated Split Greater Tuberosity Fracture (mutch type II) of Proximal Humerus with Modified PHILOS

Excellent clinical and radiological outcomes after arthroscopic reduction and double row‐suture bridge for large‐sized greater tuberosity fractures of the humerus

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