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.
|Satisfactory reduction of the greater tuberosity after the glenohumeral joint is reduced|
- Closed reduction of glenohumeral joint is successful
- Patient can be observed for possible redisplacement
- Risks of surgery outweigh benefits
- No operative risks
- No anesthetic risks
- Possibility of displacement
- Initially limited use
|MIO - Screw fixation|
|Persistent displacement of the greater tuberosity after reduction of the glenohumeral dislocation|
- Anticipated coraco-acromial impingement
- Possibility of further displacement
- Ability to correct displacement
- Earlier mobilization might be achievable under favorable circumstances
- Risk of secondary loss of reduction
|ORIF - Screw or suture fixation|
|Persistent or recurrent displacement of the greater tuberosity after reduction of the glenohumeral dislocation|
- Unacceptable displacement
- Need for more stability and/or earlier mobilization
- Best ability to reduce and stably fix
- Limited mobilization is usually possible
- Potentially more surgical trauma than closed reduction internal fixation
- Possible increased risk of shoulder stiffness
|Basic surgical experience, no specialized skills|
|Some specialized surgical experience|
|Highly experienced and skilled surgeon|
|Basic equipment only|
|Simple surgical and imaging resources|
|Full specialized surgical and imaging resources|