Reduction of the greater tuberosity
One can try to reduce the greater tuberosity closed, though this is unlikely to succeed. A manipulative reduction with a threaded pin through a stab incision under image intensification often works. If not, open reduction is required.
Closed reduction maneuver
In a slender patient, with the arm slightly abducted, it may be possible to press the greater tuberosity fragment into position with your thumb.
Under image intensifier control, make a small stab incision over the lateral aspect of the greater tuberosity fragment. Spread the deltoid muscle gently and insert a small elevator, ball-spiked pusher, or hook. To reduce the greater tuberosity, apply the instrument to its upper border and …
… push it into its bed.
Temporary fixation of the greater tuberosity
The K-wire(s) is inserted while the reduction is maintained with the instrument.
Confirmation of reduction
Reduction and proper placement of the K-wire should be confirmed under image intensifier control.