Isolated fracture of the lesser tuberosity of the humerus – a rare injury that requires surgical treatment
Abstract
Introduction. An isolated fracture of the small tuberosity is a very rare injury that can often be overlooked. That injury is significant due to the function of the subscapularis muscle, which loses its attachment by separating the small tuberosity. Case report. A 45-year-old male, former athlete, suffered a left shoulder injury while falling downhill. Although the clinical picture was not convincing, a computed tomography scan showed a fracture. Open repositioning and osteosynthesis were performed. After rehabilitation, the patient regained a full active range of motion in the shoulder joint three months after the operation. We present the mechanism of injury, clinical picture, necessary diagnostics, and technique of surgical treatment of isolated fracture lesser tuberosity of the humerus. The results of other authors whose series are also quite small were analyzed. Conclusion. It was concluded that an isolated fracture of the small tuberosity requires surgical treatment to preserve a good range of motion in the shoulder joint.
References
1. Jakob RP, Kristiansen T, Mayo K, Ganz R, Muller ME. Classifica-tion and aspects of treatment of fractures of the proximal hu-merus. Philadelphia: BC Decker; 1984.
2. Robinson CM, Teoh KH, Baker A, Bell L. Fractures of the lesser tuberosity of the humerus. J Bone Joint Surg Am 2009; 91(3): 512‒20.
3. Streubel PN, Sanchez-Sotelo J, Steinmann SP. Proximal Humeral Fractures. In: Buchholz RW, Court-Brown CM, Heckman JD, Tor-net P, editors. Rockwood and Green’s Fractures in Adults. Philadelphia: Lippincott Williams and Wilkins; 2015. P. 1341‒427.
4. Kanso I, Bricout JM. Isolated avulsion fracture of the lesser tu-berosity of the humerus. Apropos of a case. Rev Chir Orthop Reparatrice Appar Mot 1998; 84(6): 554‒7. (French)
5. Vezeridis PS, Bae DS, Kocher MS, Kramer DE, Yen YM, Waters PM. Surgical treatment for avulsion injuries of the humeral lesser tuberosity apophysis in adolescents. J Bone Joint Surg Am 2011; 93(20): 1882‒8.
6. Tosun B, Kesemenli CC. Isolated avulsion fracture of lesser tu-berosity of the humerus: Review of the literature and report of two cases. Int J Shoulder Surg 2011; 5(2): 50‒3.
7. Van Laarhoven HA, te Slaa RL, van Laarhoven EW. Isolated avulsion fracture of the lesser tuberosity of the humerus. J Trauma 1995; 39(5): 997‒9
8. Vavken P, Bae DS, Waters PM, Flutie B, Kramer DE. Treating Subscapularis and Lesser Tuberosity Avulsion Injuries in Skel-etally Immature Patients: A Systematic Review. Arthroscopy 2016; 32(5): 919‒28.
9. Ross GJ, Love MB. Isolated avulsion fracture of the lesser tu-berosity of the humerus: Report of two cases. Radiology 1989; 172(3): 833‒4.
10. Pace A, Ribbans W, Kim JH. Isolated lesser tuberosity fracture of the humerus. Orthopedics 2008; 31: 94.
11. Jaya TS, Hadizie D, Muzaffar TMS. Isolated Avulsion Fracture Lesser Tuberosity of the Humerus, a Rare Presentation Post Seizure. Trauma Cases Rev 2019; 5(3): 078.
12. Ogawa K, Takahashi M. Long-term outcome of isolated lesser tuberosity fractures of the humerus. J Trauma 1997; 42: 955-9.
13. Mora Guix JM, Gonzalez AS, Brugalla JV, Carril EC, Baños FG. Proposed protocol for reading images of humeral head frac-tures. Clin Orthop Relat Res 2006; 448: 225‒33.
14. Symeonides PP. The significance of the subscapularis muscle in the pathogenesis of recurrent anterior dislocation of the shoulder. J Bone Joint Surg Br 1972; 54(3): 476‒83.
15. Hung LH, Chung KY, Tang N, Leung KS. Isolated avulsion fracture of the lesser tuberosity of the humerus: Case report and literature review. J Orthop Trauma Rehabil 2012; 16: 78–81.
16. Paschal SO, Hutton KS, Weatherall PT. Isolated avulsion frac-ture of the lesser tuberosity of the humerus in adolescents. A report of two cases. J Bone Joint Surg Am 1995; 77(9): 1427‒30.
17. Spek RWA, Schoolmeesters BJA, den Haan C, Jaarsma RL, Doorn-berg JN, van den Bekerom MPJ. What are the patient-reported outcomes, functional limitations, and complications after lesser tuberosity fractures? a systematic review of 172 patients. JSES Int 2021; 5(4): 754–64.
18. Gruson KI, Ruchelsman DE, Tejwani NC. Isolated tuberosity frac-tures of the proximal humerus: Current concepts. Injury 2008; 39(3): 284‒98.
19. Cheng R, Moran J, Smith S, Li D, Schneble CA, Chan SM, et al. Lesser Tuberosity Avulsion Fracture in an 11-Year-Old Base-ball Player due to Batting. Case Rep Orthop 2021; 2021: 2396200.
20. Levine B, Pereira D, Rosen J. Avulsion fractures of the lesser tuberosity of the humerus in adolescents: Review of the lit-erature and case report. J Orthop Trauma 2005; 19(3): 349–52.
21. Park SG, Shim BJ, Seok HG. Isolated avulsion fracture of the lesser tuberosity of the humerus in an adolescent amateur box-er. JSES Int 2020; 4(4): 759–764.
22. Choi C, Lee SJ, Choo HJ, Lee IS, Kim SK. Avulsion injuries: an update on radiologic findings. Yeungnam Univ J Med 2021; 38(4): 289–307.
23. Goeminne S, Debeer P. The natural evolution of neglected lesser tuberosity fractures in skeletally immature patients. J Shoulder Elbow Surg 2012; 21(8): e6‒11.