Reconstruction of a massive avulsion fracture of the lesser tuberosity using the arthroscopic tension band technique: a case report and brief review of the literature

Abstract

Abstract An isolated avulsion fracture of the lesser tuberosity (LT) of the humerus is highly uncommon in the adult population. Although the advantages of arthroscopy are well-known, to date, only three adult cases have been reported in the literature, with each exhibiting technical differences. The patient was a 57-year-old woman who presented with right shoulder pain after falling one month before. Computed tomography (CT) and magnetic resonance imaging (MRI) showed a retracted avulsion fracture of the entire LT with an intact subscapularis tendon. Arthroscopic repair was performed using the tension band technique. The shoulder was immobilized with a sling for three weeks, allowing limited passive motion, except for external rotation. Next, the patient was sent to physical therapy, progressing with an active range of motion. MRI at 5 months confirmed that the fracture had healed in good position. The evaluation performed 1 year after surgery showed a highly satisfied patient who can perform all daily activities with a pain-free range of motion. Isolated avulsion fractures of the LT can be successfully repaired using arthroscopic-assisted tension band fixation. This technique provides secure fixation even in the presence of osteoporotic bone, thereby enabling early rehabilitation and good expectation of an excellent outcome.