Displacement of More than Three Millimeters Might Influence Shoulder Function: A Retrospective Analysis of Minimally Displaced Fractures of the Greater Tuberosity

Abstract

There is no clear evidence in the literature as to whether minimally displaced fractures of the greater tuberosity should be reduced and stabilised by operative means or if the results of conservative treatment are good. The aim of this study was to find out if the amount of displacement in conservatively treated patients had an effect on shoulder function. We were able to examine 135 patients with fractures of the greater tuberosity treated between 1992 and 2000 at an average time of 3.7 (2-10) years after trauma. The results showed that patients with less than 4 millimeters of displacement had the same outcome with either simple shoulder slings or with Gilchrist bandages. Displacement of less than 4 millimeters appeared to have no effect on shoulder function. However, patients with a displacement of more than three millimeters obviously had a worse result compared to the patients with less displacement. We suggest cheaper shoulder slings for conservative treatment and operative treatment in patients with a displacement of more than three millimeters.

Key words

Greater tuberosity - displaced fractures - shoulder function

References

• 1 Bono C M, Renard R, Levine R G, Levy A S. Effect of displacement of fractures of the greater tuberosity on the mechanics of the shoulder.  J Bone Joint Surg [Br]. 2001;  83 1056-1062
• 2 Connor P, Flatow E. Complications of internal fixation of proximal humeral fractures. In: Springfield D (ed). Instructional Course Lectures. American Academy of Orthopaedic Surgeons, Rosemont 1997; 25-37
• 3 Constant C R, Murley A H G. A clinical method of functional assessment of the shoulder.  Clinical Orthopaedics and Related Research. 1987;  214 160-164
• 4 De Palma A, Cautill R. Fractures of the upper end of the humerus.  Clin Orthop. 1961;  20 73-93
• 5 Gäbler Chr, Matis N, Rohrbacher A, Kwasny O, Vécsei V. Functional assessment of the shoulder. Vienna Shoulder Score (VSS) versus UCLA Score.  Osteosynthese International. 1998;  6 271-276
• 6 Iannotti J, Sidor M. Malunions of the proximal humerus. In: Warner J, Iannotti J (eds). Complex and Revision in Shoulder Surgery. Lippincott-Raven, Philadelphia 1997; 245-264
• 7 Kay S P, Amstutz H C. Shoulder hemiarthroplasty at UCLA.  Clin Orthop. 1998;  288 42-49
• 8 Neer C S. Displaced proximal humeral fractures. Part I. Classification and evaluation.  J Bone Joint Surg [Am]. 1970;  52 1077-1089
• 9 Neviaser J. Complicated fractures and dislocations about the shoulder joint.  J Bone Joint Surg [Am]. 1962;  44 984-988
• 10 Park T-S, Choi I-L, Kim H-Y, Park M-R, Shon J-H, Kim S-I. A new suggestion for the treatment of minimally displaced fractures of the greater tuberosity of the proximal humerus.  Bull Hosp Joint Dis. 1997;  56 171-176
• 11 Rasmussen S, Hvass I, Dalsgaard J, Christensen B S, Holstad E. Displaced proximal humeral fractures: results of conservative treatment.  Injury. 1992;  23 41-43
• 12 Roger L F. The Shoulder and Humeral Shaft in Radiology of Skeletal Trauma. Churchill Livingston, New York 1982
• 13 Seung-Ho Kim, Kwon-Ick Ha. Arthroscopic treatment of symptomatic shoulders with minimally displaced greater tuberosity fracture.  Arthroscopy. 2000;  16 695-700
• 14 Wolf T, Schauwecker F. Zur Therapie der Tuberculum-majus-Abrisse.  Unfallchirurgie. 1987;  13 106-109
• 15 Young T, Wallace W. Conservative treatment of fractures and fracture-dislocation of the upper end of the humerus.  J Bone Joint Surg [Br]. 1985;  67 373-377