Skip to main content

Minimally Invasive Treatment of Greater Tuberosity Fractures

  • Reference work entry
  • First Online:
Minimally Invasive Surgery in Orthopedics

Abstract

The proximal humerus tends to fracture into four distinct fragments: the humeral shaft, the greater and lesser tuberosities, and the articular surface [1]. Neer based his classification system on displacement of these fragments by greater than 1 cm or angulation of more than 45°. In a retrospective review, Neer found that 85 % of fractures were considered to be minimally displaced and nonoperative management led to satisfactory results. Displaced two-part greater tuberosity fractures, according to the above criteria, were treated with open reduction and internal fixation [1, 2].

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 899.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 1,199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Neer II CS. Displaced proximal humeral fractures. Part I. Classification and evaluation. J Bone Joint Surg. 1970;52-A:1077–89.

    Google Scholar 

  2. Neer II CS. Displaced proximal humeral fractures. Part II. Treatment of three-part and four-part displacement. J Bone Joint Surg. 1970;52-A:1090–103.

    Google Scholar 

  3. McLaughlin HL. Dislocation of the shoulder with tuberosity fracture. Surg Clin N Am. 1963;43:1615–20.

    CAS  PubMed  Google Scholar 

  4. Levy AS. Greater tuberosity fractures of the humerus. Orthop Trans. 1998;22:594.

    Google Scholar 

  5. Green A, Izzi J. Isolated fractures of the greater tuberosity of the proximal humerus. J Should Elb Surg. 2003;12:641–9.

    Article  Google Scholar 

  6. Hawkins RJ, Angelo RL. Displaced proximal humeral fractures. Selecting treatment, avoiding pitfalls. Orthop Clin N Am. 1987;18:421–31.

    CAS  Google Scholar 

  7. Flatow EL, Cuomo F, Maday MG, et al. Open reduction and internal fixation of two-part displaced fractures of the greater tuberosity of the proximal part of the humerus. J Bone Joint Surg. 1991;73-A:1213–8.

    Google Scholar 

  8. Berdjiklian PK, Iannotti JP, Norris TR, et al. Operative treatment of malunion of a fracture of the proximal aspect of the humerus. J Bone Joint Surg. 1998;80-A:1484–97.

    Google Scholar 

  9. Berger RA. Total hip arthroplasty using the minimally invasive two-incision approach. Clin Orthop Relat Res. 2003;417:232–41.

    PubMed  Google Scholar 

  10. Yeung AT, Tsou PT. Posterolateral endoscopic excision for lumbar disc herniation: surgical technique, outcome, and complications in 307 consecutive cases. Spine. 2002;27:722–31.

    Article  PubMed  Google Scholar 

  11. Collinge CA, Sanders RW. Percutaneous plating in the lower extremity. J Am Acad Orthop Surg. 2000;8:211–6.

    Article  CAS  PubMed  Google Scholar 

  12. Schandelmaier P, Partenheimer A, Koenemann B, et al. Distal femoral fractures and LISS stabilization. Injury. 2001;32(S3):SC55–63.

    Article  PubMed  Google Scholar 

  13. Fankhauser F, Gruber G, Schippinger G, et al. Minimal-invasive treatment of distal femoral fractures with the LISS (Less Invasive Stabilization System): a prospective study of 30 fractures with a follow up of 20 months. Acta Orthop Scand. 2004;75:56–60.

    Article  PubMed  Google Scholar 

  14. Anglen J, Choi L. Treatment options in pediatric femoral shaft fractures. J Orthop Trauma. 2005;19:724–33.

    Article  PubMed  Google Scholar 

  15. Boldin C, Fankhauser F, Hofer HP, Szyszkowitz R. Three-year results of proximal tibia fractures treated with the LISS. Clin Orthop Relat Res. 2006;445:222–9.

    PubMed  Google Scholar 

  16. Geissler WB, Petrie SG, Savoie FH. Arthroscopic fixation of greater tuberosity fractures of the humerus (abstract). Arthroscopy. 1994;10:344.

    Google Scholar 

  17. Gartsman GM, Taverna E. Arthroscopic treatment of rotator cuff tear and greater tuberosity fracture nonunion. Arthroscopy. 1996;12:242–4.

    Article  CAS  PubMed  Google Scholar 

  18. Gartsman GM, Taverna E, Hammerman SM. Arthroscopic treatment of acute traumatic anterior glenohumeral dislocation and greater tuberosity fracture. Arthroscopy. 1999;15:648–50.

    Article  CAS  PubMed  Google Scholar 

  19. Bonsell S, Buford DA. Arthroscopic reduction and internal fixation of a greater tuberosity fracture of the shoulder: a case report. J Should Elb Surg. 2003;12:397–400.

    Article  Google Scholar 

  20. Taverna E, Sansone V, Battistella F. Arthroscopic treatment for greater tuberosity fractures: rationale and surgical technique. Arthroscopy. 2004;20:e53–7.

    Article  PubMed  Google Scholar 

  21. Carrera EF, Matsumoto MH, Netto NA, Faloppa F. Fixation of greater tuberosity fractures. Arthroscopy. 2004;20:e109–11.

    Article  PubMed  Google Scholar 

  22. Chen C, Chao E, Tu Y, et al. Closed management and percutaneous fixation of unstable proximal humerus fractures. J Trauma. 1998;45:1039–45.

    Article  CAS  PubMed  Google Scholar 

  23. Williams GR, Wong KL. Two-part and three-part fractures: open reduction and internal fixation versus closed reduction and percutaneous pinning. Orthop Clin N Am. 2000;31:1–21.

    Article  Google Scholar 

  24. Park MC, Murthi AM, Roth NS, et al. Two-part and three-part fractures of the proximal humerus treated with suture fixation. J Orthop Trauma. 2003;17:319–25.

    Article  PubMed  Google Scholar 

  25. Ogawa K, Yoshida A, Ikegami H. Isolated fractures of the greater tuberosity of the humerus: solutions to recognizing a frequently overlooked fracture. J Trauma. 2003;54:713–7.

    Article  PubMed  Google Scholar 

  26. Parsons BO, Klepps SJ, Miller S, et al. Reliability and reproducibility of radiographs of greater tuberosity displacement. J Bone Joint Surg. 2005;87-A:58–65.

    Article  Google Scholar 

  27. Sidor ML, Zuckerman JD, Lyon T, et al. The Neer classification system for proximal humeral fractures. An assessment of interobserver reliability and intraobserver reproducibility. J Bone Joint Surg. 1993;75-A:1745–50.

    Google Scholar 

  28. Siebenrock KA, Gerber C. The reproducibility of classification of fractures of the proximal end of the humerus. J Bone Joint Surg. 1993;75-A:1751–5.

    Google Scholar 

  29. Bernstein J, Adler L, Blank JE, et al. Evaluation of the Neer system of classification of proximal humeral fractures with computerized tomographic scans and plain radiographs. J Bone Joint Surg. 1996;78-A:1371–5.

    Google Scholar 

  30. Blaine TA, Bigliani LU, Levine WN. Fractures of the proximal humerus. In: Rockwood CA et al., editors. The shoulder. Philadelphia: Saunders; 2004. p. 355–412.

    Google Scholar 

  31. Sjoden GO, Movin T, Guntner P, et al. Poor reproducibility of classification of proximal humerus fractures. Additional CT of minor value. Acta Orthop Scand. 1997;68:239–42.

    Article  CAS  PubMed  Google Scholar 

  32. Burkhart SS, Lo IKY. Arthroscopic rotator cuff repair. J Am Acad Orthop Surg. 2006;14:333–46.

    Article  PubMed  Google Scholar 

  33. Kim S, Ha K, Kim S. Bankart repair in traumatic anterior shoulder instability: open versus arthroscopic technique. Arthroscopy. 2002;18:755–63.

    Article  PubMed  Google Scholar 

  34. Nam EK, Snyder SJ. The diagnosis and treatment of Superior Labrum, Anterior and Posterior (SLAP) lesion. Am J Sports Med. 2003;31:798–810.

    PubMed  Google Scholar 

  35. Lubowitz JH, Elson WS, Guttmann D. Part I: arthroscopic management of tibial plateau fractures. Arthroscopy. 2004;20:1063–70.

    Article  PubMed  Google Scholar 

  36. Ruch DS, Vallee J, Poehling GG, et al. Arthroscopic reduction versus fluoroscopic reduction in the management in the management of intra-articular distal radius fractures. Arthroscopy. 2004;20:225–30.

    Article  PubMed  Google Scholar 

  37. Schai PA, Hintermann B, Koris MJ. Preoperative arthroscopic assessment of fractures about the shoulder. Arthroscopy. 1999;15:827–35.

    Article  CAS  PubMed  Google Scholar 

  38. Carro LP, Nunez MP, Llata JIE. Arthroscopic-assisted reduction and percutaneous external fixation of a displaced intra-articular glenoid fracture. Arthroscopy. 1999;15:211–4.

    Article  CAS  PubMed  Google Scholar 

  39. Kim S, Ha K. Arthroscopic treatment of symptomatic shoulders with minimally displaced greater tuberosity fracture. Arthroscopy. 2000;16:695–700.

    Article  CAS  PubMed  Google Scholar 

  40. Jaberg H, Warner JJP, Jakob RP. Percutaneous stabilization of unstable fractures of the humerus. J Bone Joint Surg. 1992;74-A:508–15.

    Google Scholar 

  41. Naidu SH, Bixler B, Capo JT, et al. Percutaneous pinning of proximal humerus fractures: a biomechanical study. Orthopaedics. 1997;20:1073–6.

    CAS  Google Scholar 

  42. Gerber C, Schneeberger AG, Vinh T. The arterial vascularization of the humeral head: an anatomical study. J Bone Joint Surg. 1990;72-A:1486–94.

    Google Scholar 

  43. Gallo RA, Zeiders GJ, Altman GT. Two-incision technique for treatment of complex proximal humerus fractures. J Orthop Trauma. 2005;19:734–40.

    Article  PubMed  Google Scholar 

  44. Burkhead WZ, Scheinberg RR, Box G. Surgical anatomy of the axillary nerve. J Should Elb Surg. 1992;1:31–6.

    Article  Google Scholar 

  45. Hoppenfeld S, de Boer P. The shoulder. In: Hoppenfeld S, de Boer P, editors. Surgical exposures in orthopaedics: the anatomic approach. Philadelphia: Lippincott; 1994. p. 1–50.

    Google Scholar 

  46. Gardner MJ, Griffith MH, Dines JS, et al. The extended anterolateral acromial approach allows minimally invasive access to the proximal humerus. Clin Orthop Relat Res. 2005;434:123–9.

    Article  PubMed  Google Scholar 

  47. Paavolainen P, Bjorkenheim J, Slatis P, Paukku P. Operative treatment of severe proximal humeral fractures. Acta Orthop Scand. 1983;54:374–9.

    Article  CAS  PubMed  Google Scholar 

  48. Chun J, Groh GI, Rockwood CA. Two-part fractures of the proximal humerus. J Should Elb Surg. 1994;3:273–87.

    Article  CAS  Google Scholar 

  49. Hawkins RJ, Kiefer GN. Internal fixation techniques for proximal humeral fractures. Clin Orthop Relat Res. 1987;223:77–85.

    PubMed  Google Scholar 

  50. Earwaker J. Isolated avulsion fracture of the lesser tuberosity of the humerus. Skelet Radiol. 1990;19:121–5.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Brian Magovern .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this entry

Cite this entry

Magovern, B., Duralde, X., Marra, G. (2016). Minimally Invasive Treatment of Greater Tuberosity Fractures. In: Scuderi, G., Tria, A. (eds) Minimally Invasive Surgery in Orthopedics. Springer, Cham. https://doi.org/10.1007/978-3-319-34109-5_16

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-34109-5_16

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-34107-1

  • Online ISBN: 978-3-319-34109-5

  • eBook Packages: MedicineReference Module Medicine

Publish with us

Policies and ethics