Anatomical fracture reduction, provisional K-wire fixation, and stable plating are appropriate for 2 or 3-part fractures with vertical surgical neck fracture. Lesser tuberosity fractures require suture fixation, with plating of the surgical neck, as appropriate.
Reduction of the glenohumeral joint should be performed as an emergency procedure. Once the glenohumeral joint is reduced, the tuberosity fracture is treated as appropriate. If closed reduction is not successful (which is highly likely), an open reduction is required. Choose either the anterolateral or transdeltoid approach based on tuberosity fracture location.
In the following procedure, we show the reduction and fixation for fractures involving the greater tuberosity. For specific details on reduction of the lesser tuberosity see Limited open reduction and preliminary fixation of lesser tuberosity and