Executive Editor: Peter Trafton

Authors: Martin Jaeger, Frankie Leung, Wilson Li

Proximal humerus Extraarticular 2-part, greater tuberosity, displaced

back to skeleton

Glossary

General considerations

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.

Nonoperative
Main indication Skill Equipment
Frail elderly patient Basic surgical experience, no specialized skills Basic equipment only

Supporting indications

  • Risks of surgery outweigh benefits

Advantages

  • No operative risks
  • No anesthetic risks

Disadvantages

  • Reduced comfort and function
  • Greater tuberosity impingement on coraco-acromial arch
  • Possibility of further displacement
MIO - Screw fixation
Main indication Skill Equipment
Fracture that can be reduced closed Some specialized surgical experience Full specialized surgical and imaging resources

Supporting indications

  • Anticipated coraco-acromial impingement
  • Possibility of further displacement

Advantages

  • Earlier mobilization might be achievable under favorable circumstances
  • Less surgical trauma than open reduction internal fixation

Disadvantages

  • Risk of secondary loss of reduction
ORIF - Screw or suture fixation
Main indication Skill Equipment
Inability to reduce closed Some specialized surgical experience Simple surgical and imaging resources

Supporting indications

  • Unacceptable deformity
  • Need for more stability and/or earlier mobilization

Advantages

  • Best option for optimal reduction
  • Limited mobilization is usually possible

Disadvantages

  • Risk of secondary loss of reduction
  • Possible increased risk of shoulder stiffness
*Skill
Basic surgical experience, no specialized skills Basic surgical experience, no specialized skills
Some specialized surgical experience Some specialized surgical experience
Highly experienced and skilled surgeon Highly experienced and skilled surgeon
*Equipment
Basic equipment only Basic equipment only
Simple surgical and imaging resources Simple surgical and imaging resources
Full specialized surgical and imaging resources Full specialized surgical and imaging resources

v2.0 2011-05-02