Anterior traumatic shoulder dislocation associated with displaced greater tuberosity fracture: the necessity of operative treatment

OBJECTIVE: To evaluate the radiographic and clinical outcome, including the incidence of recurrence, in patients with displaced greater tuberosity (GT) fractures associated with a traumatic anterior shoulder dislocation. DESIGN: Retrospective study. SETTING: University Hospital (Level 1 trauma center). PATIENTS: There were 34 completely evaluated patients (19 male, 15 female) seen between 1993 and 2002 with a displaced GT fracture associated with a traumatic anterior shoulder dislocation. Average age was 52.8 years and the mean follow-up period was 4.8 years (range, 2.0 to 10 years). INTERVENTION: All GT fractures were internally fixed solely with heavy non-absorbable sutures and any associate rotator cuff tear was repaired at the same time. A special rehabilitation protocol was administered in all patients. MAIN OUTCOME MEASUREMENTS: Functional assessment was obtained using the parameters of the Constant score which grades outcomes as excellent, very good, good and poor. RESULTS: Overall, there were 25 (73.5%) excellent, 6 (17.6%) very good, 2 (5.8%) good and 1 (3.1%) poor results, and the average Constant score was 88.4 (range 45.0 to 100.0). All fractures healed radiographically, without evidence of secondary displacement, except in one patient. No case of recurrence of dislocation was noted in any patient. Partial absorption or "lysis" of the GT without significant clinical relevance was detected in 4 cases. CONCLUSIONS: Displaced fractures of the GT after traumatic anterior shoulder dislocation may result in limitation of motion and functional disability if they are not treated promptly by surgery. Open reduction and stable fixation of the GT along with rotator cuff repair when present, allows for early passive motion of the joint, and yields excellent final results in approximately three quarters of the patients and restores their ability to return to full activities of daily living. A compliant patient is also necessary for a successful result.