Surgical Treatment of Displaced Greater Tuberosity Fractures of the Humerus

Abstract

Greater tuberosity fractures of the humerus can be successfully treated nonsurgically in most patients. However, as little as 3 to 5 mm of superior greater tuberosity displacement may adversely affect rotator cuff biomechanics and lead to subacromial impingement in patients who are active. In these cases, surgical treatment is recommended. Multiple surgical techniques include open and arthroscopic options tailored to fracture morphology, and strategies for repair include the use of suture anchors, transosseous sutures, tension bands, and plates/screws. Three classification systems are commonly used to describe greater tuberosity fractures: the AO, Neer, and morphologic classifications. Several hypotheses have been discussed for the mechanism of greater tuberosity fractures and the deforming forces of the rotator cuff, and the use of advanced imaging is being explored.

Greater Tuberosity Fracture of the Humerus

“…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 ).…”

“…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 ).…”

“…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.…”

“…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…”

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

“…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.…”