Anterior shoulder dislocation and concomitant fracture of the greater tuberosity

Abstract

BackgroundRecurrence rates after primary traumatic shoulder dislocation are distinctly high. We hypothesized that concomitant isolated fractures of the greater tuberosity are associated with low rates of persistent instability but decreased range of motion.MethodsBetween 2007 and 2013, 66 consecutive shoulders in 64 patients were treated for primary shoulder dislocation combined with an isolated fracture of the greater tuberosity with either a nonsurgical (48 shoulders, 72.7%) or surgical (18 shoulders, 27.3%) treatment approach. In all, 55 cases (83.3%) were available for clinical follow-up examination after an average of 59.0 ± 20.7 months (range: 25–96 months) and of these, 48 (72.7%) patients consented to radiological evaluation to determine healing and position of the greater tuberosity.ResultsThe mean range of motion of the affected shoulder was significantly decreased by 9° of elevation (p = 0.016), 11° of abduction (p = 0.048), 9° of external rotation in 0° of abduction (p = 0.005), and 10° of external rotation in 90° of abduction (p = 0.001), compared with the unaffected shoulder. The mean WOSI score was 373 ± 486 points, the mean Constant and Murley score was 75.1 ± 19.4 points, and the mean Rowe score was 83 ± 20 points. Three cases (5.5%) of re-dislocation were reported among the cohort, all of them were due to a relevant trauma. Radiological evaluation revealed anatomically healed fragments in 31 shoulders (65%), dislocation of the fragment in ten shoulders (21%), impaction into the humeral head in four shoulders (8%), and absorption in three shoulders (6%).ConclusionA concomitant isolated fracture of the greater tuberosity leads to low recurrence rates along with a significant decrease in range of motion after primary traumatic anterior shoulder dislocation.

Surgical fixation of isolated greater tuberosity fractures of the humerus- systematic review and meta-analysis

“…Two studies reported exclusively on these patients. 19,20 In the remaining 14 studies, 33.9% of patients had fracturedislocations. 9,17,18,21e23,25e28,33e35,37 Six studies reported brachial plexus injuries in 13 (5.8%) patients 18e20,22,23,33 and 9 of them had poor outcomes.…”

“…(Table 1). 2 authors offered fixation in fractures displaced >1 cm 26,29 5 authors did not mention any displacement criteria 20,25,30,31,35 Remaining 15 authors accepted a 5 mm fracture displacement threshold to proceed for fixation, though one of them 19 operated upon fractures displaced >3 mm if patients were younger than 65 years. For arthroscopic fixation, 2 authors 23,24 excluded fragments larger than 2 cm, and 4 excluded fractures extending beyond the surgical neck.…”

“…Among 4 studies employing percutaneous technique, 9,19,25,27 all reported CM scores. However, no study qualified for pooling as 2 19,25 clubbed outcomes together with open techniques, while in another 2 9,28 the Standard Error could not be estimated from presented data.…”

The Shoulder Instability: An Overview

“…Those dislocations associated with a greater tuberosity fracture have less chance of recurrence and greater loss of movements of the shoulder. 19 In a meta-analysis to determine the natural history of anterior shoulder instability treated nonoperatively, the overall recurrence was 21%, but it was as high as 80% in boys less than 20 years. 20 Multiple studies have shown that surgical treatment is beneficial for the treatment of first-time dislocation in young males.…”

“…In early cases and with large bony Bankart lesions, an open reduction and fixation with screw give good results. 19 If fixation of the fragment is not possible, then a reconstruction procedure like the Latarjet procedure can be done. In cases where there is more than 25 percentage of glenoid erosion, there is a high failure rate for soft-tissue procedures, and they are better managed with an osseous reconstruction of the glenoid.…”