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Inferior displacement of greater tuberosity fracture suggests an occult humeral neck fracture: a retrospective single-centre study

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Abstract

Purpose

To radiographically characterize the relationship between inferior displacement of great tuberosity (GT) fracture and associated occult or minor displaced humeral neck fracture.

Methods

Thirty patients with inferior displacement of the GT on the initial anterior-posterior (AP) view X-ray were included in this study. Twenty-four patients received further computed tomography (CT) scans. One patient with negative CT scans underwent MRI. Radiographic indexes included the cervico-diaphyseal angle, the distance of the inferior displacement of the GT fracture, the apex-tuberosity distance, and the direction of the GT shift on the 3D-CT scan. The measurement reliability was analyzed by calculating intra-class correlation (ICC) coefficients. The relationships between the parameters were revealed using Pearson correlation analysis.

Results

In the 30 cases, humeral neck fractures were detected by AP view X-ray (6 cases), CT (23 cases), and MRI (1 case). The mean cervico-diaphyseal angle was 146.7° ± 8.9°. The mean inferior displacement of the GT fracture was 13.4 ± 5.9 mm. The mean apex-tuberosity distance was 11.8 ± 2.8 mm. Posterior/inferior displacement of the GT fractures was observed in 24 patients via CT scan. All the evaluated parameters presented correlations among methods, indicating intra-rater and inter-rater reliability. The Pearson correlation analysis revealed that inferior displacement of GT fracture was correlated with the cervico-diaphyseal angle (P < 0.05).

Conclusion

The inferior displacement of GT fracture on AP view X-ray is a useful diagnostic clue for the early recognition of occult humeral neck fracture and may indicate the need for further CT/MRI examination.

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Author notes

  1. Jianhong Wu and Zhihua Han contributed equally to this work.

Authors and Affiliations

  1. Orthopaedic Traumatology, Trauma Center, Shanghai General Hospital, School of Medicine, Shanghai Jiaotong University, 650# Xinsongjiang RD, Songjiang Area, Shanghai, 201620, China

    Jianhong Wu, Zhihua Han, Qiugen Wang & Xiaoming Wu

  2. Experimental Trauma and Orthopedics, Frankfurt Initiative for Regenerative Medicine, J.W. Goethe University, Frankfurt am Main, Germany

    Zhihua Han

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  1. Jianhong Wu
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  4. Xiaoming Wu
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Correspondence to Xiaoming Wu.

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Ethics approval and consent to participate

Given the retrospective nature of this study, written consent was not obtained. However, all patient records were anonymized prior to the analysis. Related data were obtained from the hospital’s electronic and written medical records. The study was reviewed by and obtained approval from the Institutional Review Board of Shanghai General Hospital.

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The authors declare that they have no competing interests.

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Wu, J., Han, Z., Wang, Q. et al. Inferior displacement of greater tuberosity fracture suggests an occult humeral neck fracture: a retrospective single-centre study. International Orthopaedics (SICOT) 43, 1429–1434 (2019). https://doi.org/10.1007/s00264-019-04294-1

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