Arthroscopic Management of Tuberosity Fractures

Abstract

Isolated fractures of the humeral tuberosities are rare but, when displaced, might represent insufficiency of the rotator cuff indicating surgical treatment. They can be classified into avulsion fractures, split fractures, and depression fractures, often associated with primary shoulder dislocation. An accurate imaging diagnostic involving native X-rays completed by ultrasound and/or CT scan or MRI allows for precise evaluation of fragment displacement in order to set the indication for surgical treatment. Surgery should be performed when the displacement between bony fragment and articular segment amounts for 3–5 mm for the greater tuberosity, for the lesser tuberosity even less. In most cases, surgical management can be performed arthroscopically following the principles of rotator cuff repair using suture anchors in a transosseous equivalent double-row repair technique. In solid fractures (split fractures), arthroscopically assisted screw fixation is feasible, as well. Postoperative rehabilitation protocols follow those of standard rotator cuff repair. Attention must be paid to secondary loss of reduction with indication for early revision surgery. Furthermore, postoperative adhesive capsulitis might be present more often requiring for intra-articular corticosteroid injection in order to prevent shoulder stiffness and a prolonged postoperative rehabilitation course. In general, arthroscopic management of tuberosity fractures is associated with good and reliable functional results and a low complication rate. However, surgeons should be aware of its increased technical demands with need to conversion to open surgery in some cases.