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Minimally Invasive Treatment of Greater Tuberosity Fractures

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Minimally Invasive Surgery in Orthopedics

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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

Several authors, however, have advocated treatment that is more aggressive for fractures of the greater tuberosity. Five millimeters of displacement, particularly in the superior direction, has been suggested as an indication for operative management.3–5 The major deforming forces on the greater tuberosity are the supraspinatus, infraspinatus, and teres minor, resulting in superior and/or posterior pull of the fragment. Malunion with superior displacement may lead to painful impingement and posterior displacement may result in loss of external rotation, which can be challenging to treat.6–8

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Authors and Affiliations

  1. Section of Shoulder and Elbow Surgery, Loyola University Medical Center, 2160 South First Street, Maywood, IL, USA

    Brian Magovern, Xavier Duralde & Guido Marra

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  1. Brian Magovern
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  2. Xavier Duralde
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  3. Guido Marra
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Correspondence to Guido Marra .

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Editors and Affiliations

  1. Insall Scott Kelly Institute, East 64th St. 210, New York, 10021, U.S.A.

    Giles R. Scuderi

  2. Orthopaedic Center of New Jersey, Route 27 1527, Somerset, 08873, U.S.A.

    Alfred J. Tria

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Magovern, B., Duralde, X., Marra, G. (2010). Minimally Invasive Treatment of Greater Tuberosity Fractures. In: Scuderi, G., Tria, A. (eds) Minimally Invasive Surgery in Orthopedics. Springer, New York, NY. https://doi.org/10.1007/978-0-387-76608-9_5

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  • DOI: https://doi.org/10.1007/978-0-387-76608-9_5

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