The Tuberosities

Abstract

Fractures of the greater and lesser tuberosities of the humerus are a rare clinical occurrence (20 and 2 % of all proximal humeral fractures, respectively). They often arise in association with a traumatic glenohumeral dislocation (10–30 % of cases) or as a result of a high-energy direct trauma. Recent studies have reported that approximately 60 % of such fractures remain undiagnosed at initial clinical-radiological assessment. Undisplaced fractures generally show good results if treated conservatively and with an appropriate rehabilitation program. Most authors agree that surgery is indicated when the fracture is displaced with posterosuperior dislocation of fragments. In fact, these cases often develop acromial impingement, an alteration in the balance of forces between the rotator cuff muscles and the deltoid, with resulting articular impairment especially during abduction and pseudarthrosis. In view of the above, it is crucial to formulate an early diagnosis, in some cases by means of more specific radiological investigations such as ultrasound and computed tomography (CT), and to establish which lesions really deserve an operative approach. In the event of surgery, one will have to decide whether to perform open or arthroscopic reduction and what fixation devices need to be used, on the basis of the number and size of fragments, and the extent degree of displacement.