The natural evolution of neglected lesser tuberosity fractures in skeletally immature patients

Abstract

Isolated avulsions of the lesser humeral tuberosity are rare injuries and only account for approximately 2% of all fractures of the proximal humerus. In skeletally immature patients, these fractures tend to be even more unusual. The fact that lesser tuberosity fractures in children are uncommon injuries is reflected in the paucity of literature on the management and outcome of these injuries. The first avulsion of the lesser tuberosity was described in 1895 in a 17-year-old boy with an ipsilateral humeral fracture. In 1985, White and Riley were the first to publish a formal report an isolated subscapularis avulsion in a child. So far, 33 cases of isolated avulsions of the lesser tuberosity in adolescent patients (patients aged < younger than 21 years) have been reported (Table I). One of the main reasons is that the diagnosis of this injury is not easy and often leads to a delayed diagnosis. We report 2 patients with neglected lesser tuberosity fractures during childhood and their late treatment. We also report a patient with an acute injury, treated surgically, with an excellent functional outcome.