Executive Editor: Peter Trafton

Authors: Martin Jaeger, Frankie Leung, Wilson Li

Proximal humerus Extraarticular 2-part, tuberosity, dislocation

back to skeleton

Glossary

General considerations

The glenohumeral dislocation should be reduced with closed manipulation. If closed reduction of the glenohumeral joint fails, open reduction should be performed.

Once the glenohumeral joint is reduced, these fractures should be treated according to their x-ray appearance. If closed reduction results in anatomical repositioning of the greater tuberosity, nonoperative treatment can be expected to yield good result, but serial x-rays are advised to check for redisplacement.

If the greater tuberosity is not perfectly repositioned with closed glenohumeral reduction, surgical repair of this fracture component must be considered. Displacement of more than 5 mm suggests that impingement of the tuberosity is likely, so that this threshold is often used as an indication for ORIF.

In addition to fracture displacement, morphology, bone quality, and patient factors such as age and functional demand should also be taken into consideration.

One should be aware of additional soft-tissue injuries that might require a surgical, possibly arthroscopic treatment. Therefore, further diagnostic, especially MRI, is recommended.

Remember that posterior dislocations are occasionally accompanied by a lesser tuberosity avulsion.

Nonoperative
Main indication Skill Equipment
Satisfactory reduction of the greater tuberosity after the glenohumeral joint is reduced Basic surgical experience, no specialized skills Basic equipment only

Supporting indications

  • Closed reduction of glenohumeral joint is successful
  • Patient can be observed for possible redisplacement
  • Risks of surgery outweigh benefits

Advantages

  • No operative risks
  • No anesthetic risks

Disadvantages

  • Possibility of displacement
  • Initially limited use
MIO - Screw fixation
Main indication Skill Equipment
Persistent displacement of the greater tuberosity after reduction of the glenohumeral dislocation Some specialized surgical experience Full specialized surgical and imaging resources

Supporting indications

  • Anticipated coraco-acromial impingement
  • Possibility of further displacement

Advantages

  • Ability to correct displacement
  • Earlier mobilization might be achievable under favorable circumstances

Disadvantages

  • Risk of secondary loss of reduction
ORIF - Screw or suture fixation
Main indication Skill Equipment
Persistent or recurrent displacement of the greater tuberosity after reduction of the glenohumeral dislocation Some specialized surgical experience Simple surgical and imaging resources

Supporting indications

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

Advantages

  • Best ability to reduce and stably fix
  • Limited mobilization is usually possible

Disadvantages

  • Potentially more surgical trauma than closed reduction internal fixation
  • 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