OTA 2012 Posters

Scientific Poster #94 Upper Extremity OTA-2012

Fractures of the Greater Tuberosity of the Humerus: A Retrospective Study on Function, Muscular Atrophy, and Fracture Morphology

Jennifer Mutch, MD1; Luojun Wang2; George-Yves Laflamme, MD, FRCSC1;
Nicola Hagemeister3; Dominique M. Rouleau, MD, MSc, FRCSC1;
1Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montreal, Quebec, Canada;
2Université de Montréal, Montreal, Quebec, Canada;
3Centre Hospitalier de l’Université de Montréal, École de Technologie Supérieure,
Montreal, Quebec, Canada

Purpose: 3% of upper extremity fractures occur in the proximal humerus and occur in both young and aging populations. Previous studies have demonstrated that as little as 2 mm of superior displacement of isolated greater tuberosity fractures significantly increases the force required for abduction and leads to subacromial impingement. This study describes the effect of fracture type, rotator cuff integrity, and muscular atrophy on function, range of motion, strength, and quality of life after greater tuberosity fracture.

Methods: A retrospective review of all cases of isolated greater tuberosity fractures (excluding Hill Sachs lesions) seen at a single Level I trauma center from 2006 until December 2010 was performed. 139 cases were identified and 50 patients were invited to participate in the study. Patient data were collected including age, sex, smoking status, dominance, side of injury, mechanism of injury, and treatment received. The Quick DASH (Disabilities of the Arm, Shoulder and Hand), Constant, Pain score, WORC (Western Ontario Rotator Cuff Index), and Short Form 12 v2 questionnaires were completed and a physical examination was performed by a single experienced physiotherapist. Initial and follow-up radiographs were used to classify the fractures according to the Neer, AO, and a new morphologic classification and to measure displacement in millimeters in the cranio/caudal and AP planes. A shoulder ultrasound was performed on all patients by a single musculoskeletal radiologist. Statistical analysis was performed using SPSS software (SPSS v.19, IBM).

Results: The recruited patients had an average age of 58 (range, 32-92) and 45% were male. The average WORC score following greater tuberosity fracture was 446, or 79% of expected. Patients who underwent surgical treatment had a tendency towards worse WORC scores (386 surgical vs 262 conservative) but this was not statistically significant. There was also a trend for patients with avulsion type fractures to report more persistent pain at final follow-up. The ultrasound examinations showed significant abnormalities. 66% of the patients had at least one partial tear. 14% of patients had full-thickness tears and this was significantly correlated with initial fracture displacement (P <0.05) and negative outcome (P <0.005). 53% of all patients had evidence of subacromial impingement, including 68% of patients under the age of 50. This was independent of fracture displacement or treatment.

Conclusion: This study describes the functional impact of fracture type and rotator cuff pathology associated with isolated greater tuberosity fractures of the proximal humerus. This fracture has a significant impact on shoulder function and is associated with numerous abnormalities on ultrasound examination at final follow-up. Patients with persistent pain following isolated greater tuberosity fractures may benefit from additional imaging to evaluate for associated rotator cuff injuries or impingement syndromes.

• The FDA has not cleared this drug and/or medical device for the use described in this presentation   (i.e., the drug or medical device is being discussed for an “off label” use).  ◆FDA information not available at time of printing. Δ OTA Grant.