Select a Community
Are you sure you want to trigger topic in your Anconeus AI algorithm?
You are done for today with this topic.
Would you like to start learning session with this topic items scheduled for future?
Closed reduction and immobilization in a hanging arm cast
2%
15/637
Closed reduction and percutaneous pinning
5%
30/637
Immobilization in a sling with protected range of motion
62%
396/637
Open reduction and internal fixation with a proximal humerus locking plate
14%
87/637
Open reduction and internal fixation with a suture cerclage and tension band construct
16%
104/637
Please Login to see correct answer
Select Answer to see Preferred Response
The patient has sustained an isolated, minimally displaced greater tuberosity fracture of the proximal humerus. Given the anatomic positioning of the tuberosity relative to top of the humeral head, initial non-operative management should be successful. Isolated greater tuberosity fractures of the proximal humerus with minimal displacement can be treated non-operatively. In normal anatomy, the greater tuberosity sits ~5-8 mm below the top of the humeral head. Displacement greater than 5 mm, especially posterior displacement, compromises the function of the rotator cuff tendons that insert onto the tuberosity and increase the risk of malunion and/or nonunion. Thus, in the absence of a medical contraindication, greater tuberosity fractures with greater than 5 mm of displacement will benefit from and should be treated with open reduction and surgical fixation. Rouleau et al. reviewed the surgical treatment of displaced fractures of the greater tuberosity of the proximal humerus. The authors note that as little as 5 mm of superior greater tuberosity displacement may adversely affect rotator cuff biomechanics and lead to subacromial impingement in patients who are active. They conclude that, in these cases, surgical treatment is recommended, with treatment options including the use of suture anchors, transosseous sutures, tension bands, and plates/screws. Bono et al. reviewed the effects of displacement of fractures of the greater tuberosity on the mechanics of the shoulder. Using a dynamic biomechanical model of malunion in 8 cadaveric shoulders, the authors found that abduction force was significantly increased by 16% and 27% by superior displacements of 0.5 cm and 1 cm, respectively, while combined superior and posterior displacement of 1 cm gave an increase in force of 29%. This led them to conclude that even small amounts of residual displacement may alter the balance of forces required to elevate the arm at the glenohumeral joint.Figures A and B are AP and axillary lateral radiographs of the proximal humerus showing a minimally displaced greater tuberosity fracture without posterosuperior displacement as shown on the axillary view. Incorrect Answers: Answers 1-2: Closed reduction is not indicated in this minimally displaced fracture. Answers 4-5: Either of these treatment options would be indicated if the patient had displacement of the fracture fragment >5 mm from the tuberosity's normal anatomic position 6-8mm below the top of the humeral head.
3.5
(13)
Please Login to add comment