Delayed Migration of Greater Tuberosity Fractures Associated With Anterior Shoulder Dislocation.

OBJECTIVES

Treatment of greater tuberosity (GT) fractures occurring during anterior shoulder dislocation generally consists of initial closed reduction of the shoulder. Undisplaced fractures are treated conservatively, whereas displaced fractures generally undergo surgical management. Our hypothesis is that many well-reduced GT fractures will migrate. The primary goal of this study is to evaluate the outcomes of GT fractures associated with shoulder dislocation to optimize their management.

DESIGN

Retrospective review with prospective outcomes.

SETTING

Tertiary Level 1 trauma center.

PATIENTS

A total of 55 patients with anterior shoulder dislocation and GT fractures were identified. A matched cohort of isolated GT fractures was also identified.

INTERVENTION

Closed reduction versus open reduction with or without fixation.

OUTCOME MEASUREMENTS

Radiographs were evaluated for initial displacement, reduction, Hill-Sachs lesion, and subsequent displacement. Patients were evaluated using the Constant and quick DASH scores at a minimum of 1 year of follow-up.

RESULTS

A majority of patients received initial closed reduction, with acceptable reduction of the tuberosity in 85%. With closed reduction, migration of the GT was seen in 9 cases (16%). In younger patients (<70 years), the failure rate increased to 26%. Displacement of the GT was 5.6 times more likely with dislocation than without. Patients with migration were only operated on in 33% of cases, mostly because of late presentation.

CONCLUSIONS

Treatment of GT fractures occurring with anterior shoulder dislocation is complex. Although outcomes with nonoperative treatment are generally acceptable, a significant proportion of these patients will have tuberosity migration, which may impact function.

LEVEL OF EVIDENCE

Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.