Abstract
BackgroundFractures of the greater tuberosity may result from a variety of mechanisms. Missed injury remains a persistent problem, both from a clinical and medico-legal point-of-view. Few studies on this topic are available in the literature. We present the clinical and radiological findings of a consecutive series of 17 patients who were diagnosed and managed with undisplaced greater tuberosity fractures.MethodsA retrospective study of a consecutive series of 17 patients who sustained an occult greater tuberosity fracture were performed. Patients sustained a traumatic occult greater tuberosity fracture, underwent shoulder radiographs after trauma in 5 days and they were diagnosed as negative by a consultant radiologist. All patients received a standard assessment using MRI (Magnetic Resonance Imaging) scans Each patient was evaluated for arm dominance, trauma history, duration and type of symptoms and post-treatment Oxford Shoulder Score.ResultsAt the final follow up the mean OSS (Oxford Shoulder Score) was 38.3 (range 17–46; SD 9.11). Three patients required a glenohumeral joint injection for post-traumatic pain and stiffness and three patients required subacromial decompression for post-traumatic impingement.ConclusionsThough undisplaced greater tuberosity fracture can be managed non-operatively with good results, patients with persistent post-traumatic shoulder pain, tenderness and limitation of shoulder function warrant investigation with MRI to identify occult fractures. Prompt identification of these fractures can facilitate patient treatment and counselling, avoiding a source of patient dissatisfaction and litigation.
Highlights
Fractures of the greater tuberosity may result from a variety of mechanisms
We present the clinical and radiological findings of a consecutive series of 17 patients who were diagnosed and managed with undisplaced greater tuberosity fractures
Eligibility criteria Patients were included in the study if (1) they sustained an occult greater tuberosity fracture, (2) they had a traumatic shoulder injury, (3) they underwent shoulder radiographs after trauma in 5 days and they were
Summary
Fractures of the greater tuberosity may result from a variety of mechanisms. Missed injury remains a persistent problem, both from a clinical and medico-legal point-of-view. The most common are avulsion injuries such associated with anterior shoulder dislocation, or direct trauma, as might occur in a fall on the shoulder or with hyperabduction and impaction of the greater tuberosity against the surrounding bone structures [1, 2]. These fractures can be misdiagnosed, as radiographs of the shoulder are often insufficient to confirm the diagnosis [2], especially in the case of undisplaced fractures and if the radiographic series does not include an anteroposterior (AP) view with the arm in external rotation [2, 3]. Few studies on this topic are available in the literature
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