Anterior shoulder dislocation and concomitant fracture of the greater tuberosity

Background

Recurrence rates after primary traumatic shoulder dislocation are distinctly high. We hypothesized that concomitant isolated fractures of the greater tuberosity are associated with low rates of persistent instability but decreased range of motion.

Methods

Between 2007 and 2013, 66 consecutive shoulders in 64 patients were treated for primary shoulder dislocation combined with an isolated fracture of the greater tuberosity with either a nonsurgical (48 shoulders, 72.7%) or surgical (18 shoulders, 27.3%) treatment approach. In all, 55 cases (83.3%) were available for clinical follow-up examination after an average of 59.0?± 20.7 months (range: 25–96 months) and of these, 48 (72.7%) patients consented to radiological evaluation to determine healing and position of the greater tuberosity.

Results

The mean range of motion of the affected shoulder was significantly decreased by 9° of elevation (p?=?0.016), 11° of abduction (p?=?0.048), 9° of external rotation in 0° of abduction (p?=?0.005), and 10° of external rotation in 90° of abduction (p?=?0.001), compared with the unaffected shoulder. The mean WOSI score was 373?± 486 points, the mean Constant and Murley score was 75.1?± 19.4 points, and the mean Rowe score was 83?± 20 points. Three cases (5.5%) of re-dislocation were reported among the cohort, all of them were due to a relevant trauma. Radiological evaluation revealed anatomically healed fragments in 31 shoulders (65%), dislocation of the fragment in ten shoulders (21%), impaction into the humeral head in four shoulders (8%), and absorption in three shoulders (6%).

Conclusion

A concomitant isolated fracture of the greater tuberosity leads to low recurrence rates along with a significant decrease in range of motion after primary traumatic anterior shoulder dislocation.