Isolated fractures of the greater tuberosity of the proximal humerus: a long-term retrospective study of 30 patients

Abstract

Background and purpose: The diagnosis and treatment of isolated greater tuberosity fractures of the proximal humerus is not clear-cut. We retrospectively assessed the clinical and radiographic outcome of isolated greater tuberosity fractures.

Patients and methods: 30 patients (mean age 58 (26-85) years, 19 women) with 30 closed isolated greater tuberosity fractures were reassessed after an average follow-up time of 3 years with DASH score and Constant score. Radiographic outcome was assessed on standard plain radiographs.

Results: 14 of 17 patients with undisplaced or slightly displaced fractures (≤ 5 mm) were treated nonoperatively and had good clinical outcome (mean DASH score of 13, mean Constant score of 71). 8 patients with moderately displaced fractures (6-10 mm) were either treated nonoperatively (n = 4) or operatively (n = 4), with good functional results (mean DASH score of 10, mean Constant score of 72). 5 patients with major displaced fractures (> 10 mm) were all operated with good clinical results (mean DASH score of 14, mean Constant score of 69). The most common discomfort at the follow-up was an impingement syndrome of the shoulder, which occurred in both nonoperatively treated patients (n = 3) and operatively treated patients (n = 4). Only 1 nonoperatively treated patient developed a non-union. By radiography, all other fractures healed.

Interpretation: We found that minor to moderately displaced greater tuberosity fractures may be treated successfully without surgery.

Figure 1.

The left shoulder of a 64-year-old patient (no. 3, Table 3), who suffered an anterior glenohumeral dislocation of the left shoulder with an avulsed greater tuberosity.

Figure 2.

Patient no. 9 (Table 3) before and after open reduction and internal fixation with cannulated screws of a moderately displaced fracture of the greater tuberosity (white arrows). An MRI scan illustrates the fracture line (white arrows).

Figure 3.

Patient no. 6 (Table 3) before and after open reduction and internal fixation of greater tuberosity fragments with major displacement (white arrows). The multiple fragments were fixed with a screw and a tension wire.

Figure 4.

Patient no. 18 (Table 3) before and after open reduction and plate fixation of a moderately displaced fracture of the greater tuberosity (white arrows).

Figure 5.

Radiographs of the right shoulder illustrating severe periarticular calcification (white arrows) of a patient (no. 30, Table 3) who was treated operatively with ORIF with screws for a major displaced fracture of the greater tuberosity. After radiographic healing, the metal was removed.