Review Question - QID 216917

This patient has a displaced greater tuberosity fracture. Displacement >5mm will result in impingement with loss of abduction and external rotation.

Greater tuberosity fractures may occur with a traumatic dislocation of the shoulder. Greater tuberosity fracture displacement <5mm may be successfully managed with conservative management with sling immobilization followed by progressive rehabilitation. Greater tuberosity fractures with >5mm displacement will result in altered kinematics of the shoulder secondary to impingement with loss of abduction and external rotation. Open reduction and internal fixation should be implemented in greater tuberosity fractures with >5mm of displacement.

Mattyasovszky et al. retrospectively reviewed the clinical and radiographic outcome of isolated greater tuberosity fractures. They reported that 14 of 17 patients with nondisplaced or slightly displaced fractures (≤ 5 mm) that were treated nonoperatively had good clinical outcome, while those with major displaced fractures (> 10 mm) that were treated surgically had good clinical results. They noted that the most common discomfort at the follow-up was an impingement syndrome of the shoulder. They concluded that minor to moderately displaced greater tuberosity fractures may be treated successfully without surgery.

Platzer et al. reviewed the relationship between degree of displacement in non-operatively treated patients and shoulder function. They reported that displacement of >3mm had slightly worse results compared to those with less displacement. They concluded that non-operative treatment in patients with minimally displaced fractures of the greater tuberosity may result in good results.

George et al. reviewed isolated fractures of the greater tuberosity of the humerus. They reported that nondisplaced and minimally displaced fractures are typically treated successfully nonsurgically. They concluded that surgical fixation is recommended for fractures with >5mm of displacement in the general population or >3mm of displacement in active patients involved in frequent overhead activity.

Figure A is the AP radiograph of the shoulder revealing a fracture-dislocation of the shoulder

Incorrect Answers:
Answers 2-5: Greater tuberosity fractures with >5mm displacement will result in altered kinematics of the shoulder secondary to impingement with loss of abduction and external rotation