Lesser Tuberosity Fractures

- See: Fracture Dislocation:

- Discussion:
    - pure avulsions of the lesser tuberosity are rare;
    - pressence of this frx raises possibility of assoicatted posterior dislocation;
    - lesser tuberosity fragment consists of the lesser tuberosity with its attached subscapularis muscle;
    - avulsion of this frag may allow undue external rotation of humeral neck frx;
    - two part lesser tuberosity frx are usually associated w/ posterior glenohumeral dislocation;
    - small fragments can be treated without surgery;
    - three part lesser tuberosity fractures:
         - greater tuberosity is attached to the head;
         - lies in internal rotation: articular surface faces posteriorly;
         - shaft is pulled medially by the pectoralis major;
         - long head of biceps may also be caught between fragments which obstructs reduction;

- Radiographs:
    - attempt to get Axillary View since it is not only diagnostic of shoulder dislocation but also allows assessment of humeral head compression frx, glenoid frx, & lesser tuberosity frx of the humerus;

- Surgical Treatment: Two Part Frx:
    - dynamic compression: either by tension band stabilization or incorporation of tuberosity fragment in a tension band plate;
    - occassionally, cancellous lag screws with washers may be used to achieve stable fixation;
    - rare frx, which may be assoic w/ posterior dislocation frx;
    - if this frx is small and does not block medial rotation, successful treatment by closed  reduction is possible;
    - displacement of tuberosity & attached subscapularis insertion in absence of assoc dislocation rarely results in functional deficit

Year Book: Open Reduction and Internal Fixation of Two-Part Displaced Fractures of the Greater Tuberosity of the Proximal Part of the Humerus.

Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Sunday, June 24, 2012 5:52 pm