Department of Trauma Surgery, Center for Musculoskeletal Surgery, Johannes Gutenberg University Mainz, Germany.
Acta Orthop. 2011 Dec;82(6):714-20. doi: 10.3109/17453674.2011.618912. Epub 2011 Sep 6.
The diagnosis and treatment of isolated greater tuberosity fractures of the proximal humerus is not clear-cut. We retrospectively assessed the clinical and radiographic outcome of isolated greater tuberosity fractures.
30 patients (mean age 58 (26-85) years, 19 women) with 30 closed isolated greater tuberosity fractures were reassessed after an average follow-up time of 3 years with DASH score and Constant score. Radiographic outcome was assessed on standard plain radiographs.
14 of 17 patients with undisplaced or slightly displaced fractures (≤ 5 mm) were treated nonoperatively and had good clinical outcome (mean DASH score of 13, mean Constant score of 71). 8 patients with moderately displaced fractures (6-10 mm) were either treated nonoperatively (n = 4) or operatively (n = 4), with good functional results (mean DASH score of 10, mean Constant score of 72). 5 patients with major displaced fractures (> 10 mm) were all operated with good clinical results (mean DASH score of 14, mean Constant score of 69). The most common discomfort at the follow-up was an impingement syndrome of the shoulder, which occurred in both nonoperatively treated patients (n = 3) and operatively treated patients (n = 4). Only 1 nonoperatively treated patient developed a non-union. By radiography, all other fractures healed.
We found that minor to moderately displaced greater tuberosity fractures may be treated successfully without surgery.
孤立性肱骨大结节骨折的诊断和治疗尚不明确。我们回顾性评估了孤立性肱骨大结节骨折的临床和影像学结果。
30 例(平均年龄 58 岁[26-85 岁],19 例女性)患者,30 例闭合性孤立性肱骨大结节骨折患者,平均随访 3 年,采用 DASH 评分和 Constant 评分进行评估。影像学结果通过标准的平片进行评估。
17 例无移位或轻度移位(≤5mm)骨折患者中,14 例接受非手术治疗,临床结果良好(平均 DASH 评分为 13,平均 Constant 评分为 71)。8 例中度移位(6-10mm)骨折患者,4 例接受非手术治疗,4 例接受手术治疗,功能结果良好(平均 DASH 评分为 10,平均 Constant 评分为 72)。5 例大块移位(>10mm)骨折患者均接受手术治疗,临床结果良好(平均 DASH 评分为 14,平均 Constant 评分为 69)。随访时最常见的不适是肩部撞击综合征,非手术治疗患者(n=3)和手术治疗患者(n=4)均有发生。仅有 1 例非手术治疗患者发生骨不连。影像学上,所有其他骨折均愈合。
我们发现,轻微到中度移位的肱骨大结节骨折可以成功地不进行手术治疗。