Abstract
It is assumed that dorsocranial displacement of the greater tuberosity in humeral head fractures is caused by rotator cuff traction. The purpose of this study was to investigate the association between rotator cuff status and displacement characteristics of the greater tuberosity in four-part humeral head fractures. Computed tomography scans of 121 patients with Neer type 4 fractures were analyzed. Fatty infiltration of the supra- and infraspinatus muscles was classified according to Goutallier. Position determination of the greater tuberosity fragment was performed in both coronary and axial planes to assess the extent of dorsocranial displacement. Considering non-varus displaced fractures, the extent of the dorsocranial displacement was significantly higher in patients with mostly inconspicuous posterosuperior rotator cuff status compared to advanced fatty degenerated cuffs (cranial displacement: Goutallier 0–1: 6.4 mm ± 4.6 mm vs. Goutallier 2–4: 4.2 mm ± 3.5 mm, p = 0.020; dorsal displacement: Goutallier 0–1: 28.4° ± 32.3° vs. Goutallier 2–4: 13.1° ± 16.1°, p = 0.010). In varus displaced humeral head fractures, no correlation between the displacement of the greater tuberosity and the condition of the posterosuperior rotator cuff could be detected (p ≥ 0.05). The commonly accepted theory of greater tuberosity displacement in humeral head fractures by rotator cuff traction cannot be applied to all fracture types.
Highlights
In 1970, Neer established a new classification system for proximal humeral fractures that is still widely used in clinical practice today [1]
It is assumed that dorsocranial displacement of the greater tuberosity in humeral head fractures is caused by rotator cuff traction
Considering non-varus displaced fractures, the extent of the dorsocranial displacement was significantly higher in patients with mostly inconspicuous posterosuperior rotator cuff status compared to advanced fatty degenerated cuffs
Summary
In 1970, Neer established a new classification system for proximal humeral fractures that is still widely used in clinical practice today [1]. This classification system is based on the four main fracture fragments (humeral shaft, calotte, and greater and lesser tuberosity), firstly described by Codman in 1934 [2]. Neer assumed that traction of the rotator cuff is responsible for the characteristic fragment displacement, especially of the greater tuberosity. The supraspinatus and infraspinatus tendons are known to be responsible for the dorsocranial displacement of this key fragment [1]. In elderly patients with humeral head fractures, concomitant chronic degenerative rotator cuff pathologies are common [3,4]. For example, found rotator cuff lesions in 80% of asymptomatic patients 80 years of age and older [5]
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