General considerations

The glenohumeral dislocation of an A1.3 fracture (anterior dislocation plus greater tuberosity avulsion) 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, A1.3 fractures convert into A1.1 or A1.2 fractures. If closed reduction results in anatomical repositioning of the greater tuberosity, nonoperative treatment can be expected to yield good result.

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 (classified as A1.3.4).