(a) Most fractures are treated with open surgery. Screws or metal wires are used to hold the fragment in place. At the Cape Shoulder Institute, a new technique has been developed that uses tiny metal anchors and sutures to tie the fractured fragment to the avulsion site.
||Double-row fixation technique.
||Operative treatment of a greater Tuberosity fracture with suture-anchors.
Some of these fractures can be treated by arthroscopic surgery using a technique developed at the Cape Shoulder Institute. Partial cuff tears can also be treated by arthroscopy.
Left: Arthroscopic fixation of a fractured greater tuberosity is demonstrated. Right: Diagnostic arthroscopy reveals a partial tear of the rotator cuff.
2. Lesser tuberosity fractures
These usually result from posterior shoulder dislocations, or from violent muscle contraction due to electric shock or convulsions.
||Arrow shows a lesser tuberosity fracture on a 3D CT scan.
Treatment consists of open surgical fixation of the fractured fragment using sutures through bone and anchors, similar to greater tuberosity fractures.
Neglect of these fractures leads to deficiency of the subscapularis muscle, an important shoulder stabilizer and mobilizer. Long term deficiency of this muscle may necessitate a major muscle transfer procedure.
3. Surgical neck fractures
These are common in osteoporotic bone. These fractures can result in damage to the axillary nerve that runs along the surgical neck.
Left: Use of allograft bone in augmentation of surgical fixation. Right: Use of plate and screws to fix proximal humerus fractures.