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