Executive Editor: Peter Trafton

Authors: Martin Jaeger, Frankie Leung, Wilson Li

Proximal humerus Extraarticular 3-part, surgical neck and greater tuberosity, impaction

General considerations

Tuberosity malunion or nonunion, and secondary fracture displacement can be problematic for these injuries. However, the humeral head blood supply is seldom totally disrupted, thus avascular necrosis is unusual.

Surgical treatment for the greater tuberosity fragment must correct any displacement greater than 5 mm and provide stable fixation for early motion. Tuberosity fixation can be supplemented with a tension band suture through its rotator cuff insertion for increased stability. If surgery is done, fixation of the metaphyseal (surgical neck) component is typically included.

A significantly displaced greater tuberosity fracture will impinge on the coraco-acromial arch. This causes painful reduction of motion. Nonoperative treatment will not correct this and should be reserved for patients with unacceptably high surgical risk. If the greater tuberosity is not significantly displaced, conservative treatment may be considered, and can give good results.

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v2.0 2011-05-02