Diagnosis

Extraarticular 2-part fracture of tuberosity

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These fractures are unifocal extraarticular proximal humerus fractures involving the greater tuberosity.

The greater tuberosity is the attachment of supraspinatus and infraspinatus tendons and its integrity is important for proper shoulder function. Proximal displacement, even as little as 5 mm, of a fracture of the greater tuberosity compromise shoulder abduction. This is due to tuberosity impingement on the coracoacromial arch and/or shortening of the involved rotator cuff tendons.

Displaced tuberosity fractures must be distinguished from those which are truly undisplaced. The later usually heal without compromising shoulder function.

Options
1.  Nondisplaced greater tuberosity
2.  Displaced greater tuberosity
3.  Fracture of tuberosity with glenohumeral dislocation

1.  Nondisplaced greater tuberosity

Nondisplaced greater tuberosity

Nondisplaced greater tuberosity

This subgroup consists of fractures of the greater tuberosity which are truly not displaced. They heal typically very well under conservative treatment and do not tend to displace during the healing period.

2.  Displaced greater tuberosity

Displaced greater tuberosity

Displaced greater tuberosity

This subgroup consists of fractures of the greater tuberosity which are superiorly and/or posteriorly displaced.

The typical displacement of the greater tuberosity is posterosuperiorly.

A displacement more than 5 mm is usually considered significant and should be treated surgically.

Displaced greater tuberosity

Displaced greater tuberosity

3.  Fracture of tuberosity with glenohumeral dislocation

Fracture of tuberosity with glenohumeral dislocation

Fracture of tuberosity with glenohumeral dislocation

These fractures are those associated with glenohumeral dislocations. The vast majority involve the greater tuberosity. Occasionally, a posterior dislocation results in avulsion of the lesser tuberosity. Very rarely, so-called luxatio in erecta is associated with a greater tuberosity fracture. All such fracture dislocations should be reduced promptly. Beware of a possible occult metaphyseal fracture that may displace during closed reduction (converting the fracture to a 3 or 4-part fracture). Tuberosity displacement must be reassessed after glenohumeral reduction, since it may not require surgical repair. With any glenohumeral fracture dislocation, an open reduction may be necessary. 

Fracture of tuberosity with glenohumeral dislocation

Fracture of tuberosity with glenohumeral dislocation