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Proximal Humeral Fractures

Patient Information
Shoulder Fractures
Proximal Humeral Fractures
Proximal Humeral FracturesProximal Humeral Fractures
Locking Plate FixationLocking Plate Fixation
Shoulder Replacement for FractureShoulder Replacement for Fracture
Greater Tuberosity FracturesGreater Tuberosity Fractures

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Greater Tuberosity Fractures

Isolated displaced greater tuberosity fractures are thought to occur in less than 2% of proximal humeral fractures, and are normally associated with anterior shoulder dislocations. The greater tuberosity fragment detaches with its attached rotator cuff and will characteristically have a longitudinal tear in the cuff between the supraspinatus and subscapularis tendons. The greater tuberosity fragment is pulled superiorly by the supraspinatus and posteriorly by infraspinatus and teres minor.

As greater tuberosity fractures are usually retracted posteriorly and superiorly, a closed reduction is difficult. If left in position, impingement will develop against the acromion, limiting elevation and external rotation of the shoulder. However if the fracture is associated with anterior dislocation then a closed reduction of the glenohumeral dislocation may successfully reduce the greater tuberosity fracture, and once it has healed, recurrent anterior instability is unlikely.

The surgical approach to this fracture is much like a rotator cuff repair, anterosuperiorly, often complete with an acromioplasty. An alternative approach is a deltoid-splitting approach, but instead of taking the deltoid off the anterior acromion, it is peeled off the posterior acromion which avoids the acromioplasty and minimizes weakening of the anterior deltoid. This approach is especailly helpful if the fragment is displaced posteriorly. Fixation of smaller fractures can be accomplished with heavy sutures, wire or occasionally, screws. Rotator cuff tears associated with the fracture are also closed. If in the case of a large greater tuberosity fracture, a deltopectoral approach would allow for more adequate exposure for reduction and proper fixation.

anterior view of fixation plate (left)  superior view of humerus with screws in place (right)
The most posterior muscle and tendon of the rotator cuff. Externally rotates the shoulder in abduction.
a structure (tissue) that attaches a muscle to a bone. When a tendon becomes inflamed, the condition is referred to as tendinitis or tendonitis.
a structure (tissue) that attaches a muscle to a bone. When a tendon becomes inflamed, the condition is referred to as tendinitis or tendonitis.
Top muscle and tendon of the rotator cuff. Abducts the arm. It is the tendon that is most often torn.
at the top; towards the head
The most anterior muscle and tendon of the rotator cuff. Internally rotates the shoulder.
at the back; behind
joint is unstable; it repeatedly slips out of it's socket, recurrently dislocates or feels unstable.
muscle and tendon of the rotator cuff. Externally rotates the arm. Lies between supraspinatus and teres minor.
bone of the upper arm - connecting the shoulder to the elbow
broken bone
joint comes out of it's socket completely
at the front; in front

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