Long-term Results, Functional Outcomes and Complications after Open Reduction and Internal Fixation of Neglected and Displaced Greater Tuberosity of Humerus Fractures

Abstract

Background: Humerus fractures include 5% to 8% of total fractures. Non-union and delayed union of GT (GT) fractures is uncommon; however they present a challenge to the orthopedic surgeons. Significant controversy surrounds optimal treatment of neglected fractures. The purpose of this article was to perform a comparative study to evaluate the outcomes of open reduction and internal fixation (ORIF) of neglected GT fractures.

Methods: We retrospectively evaluated the results of surgical intervention in 12 patients with displaced nonunion of GT fractures who were referred to our center. Before and minimally 25 months after surgery ROM, muscle forces, Constant Shoulder Score (Constant-Murley score) (CSS), Visual Analogue Scale (VAS), Activities of Daily Living (ADL) Score and American Shoulder and Elbow Surgeons (ASES) Score were all recorded. Additionally, the results were compared with undamaged shoulder.

Results: Between March 2006 and January 2013, 12 patients underwent surgical intervention and followed for 36.2 months in average. All fractures healed. Anatomic reduction achieved only in 6 cases with no report of avascular necrosis or infection. All ROMs and muscle forces increased significantly (Mean Forward Flexion: 49.16 to 153.3, Mean Internal Rotation: 3 to 9, Mean External Rotation: -5 to 27.5) (P value<0.0001). All functional scores including CSS, VAS, ADL and ASES score improved significantly (Mean VAS: 6.5 to 1.3, Mean CSS: 29.83 to 86, Mean ADL: 6.6 to 27.1,: Mean ASES: 28.6 to 88.9) (P value<0.0001).

Conclusion: ORIF for neglected and displaced GT fractures has satisfactory functional outcomes, despite of non-anatomical reduction of the fracture.

Keywords: Greater tuberosity; Nonunion; Reduction; Shoulder fractures.

Figure 1

A 27-year-old man with received surgical treatment for his left shoulder 5 months after trauma; a) skin incision; b) deltoid was split and coracoacromial ligament was released; c) middle third of deltoid was detached of the acromion with a shell of bone: d) GT was released and retracted anteriorly; e) GT was fixed with transosseous sutures, and f) Transosseous fixation of the middle third of the deltoid.

Figure 2

Near full ROM of the shoulder, 2 years postoperatively in the same case that was presented in Figure 1 and 2; a) scar of surgical incision, b) forward flexion, c) internal rotation and, d) external rotation.

Figure 3

Radiography and CT scans of the same case that was presented in Figure 1. a) to d) pre-operative X-rays and CT scans and e) to f) 2 years post-operative X-rays.