Long-term Results, Functional Outcomes and Complications after Open Reduction and Internal Fixation of Neglected and Displaced Greater Tuberosity of Humerus Fractures

  Background: Humerus fractures include ۵% to ۸% of total fractures. Non-union and delayed union of GT (GT) fractures is uncommon; however they present a challenge to the orthopedic surgeons. Significant controversy surrounds optimal treatment of neglected fractures. The purpose of this article was to perform a comparative study to evaluate the outcomes of open reduction and internal fixation (ORIF) of neglected GT fractures.   Methods: We retrospectively evaluated the results of surgical intervention in ۱۲ patients with displaced nonunion of GT fractures who were referred to our center. Before and minimally ۲۵ months after surgery ROM, muscle forces, Constant Shoulder Score (Constant-Murley score) (CSS), Visual Analogue Scale (VAS), Activities of Daily Living (ADL) Score and American Shoulder and Elbow Surgeons (ASES) Score were all recorded. Additionally, the results were compared with undamaged shoulder. Results: Between March ۲۰۰۶ and January ۲۰۱۳, ۱۲ patients underwent surgical intervention and followed for ۳۶.۲ months in average. All fractures healed. Anatomic reduction achieved only in ۶ cases with no report of avascular necrosis or infection. All ROMs and muscle forces increased significantly (Mean Forward Flexion: ۴۹.۱۶ to ۱۵۳.۳, Mean Internal Rotation: ۳ to ۹, Mean External Rotation: -۵ to ۲۷.۵) (P value<۰.۰۰۰۱). All functional scores including CSS, VAS, ADL and ASES score improved significantly (Mean VAS: ۶.۵ to ۱.۳, Mean CSS: ۲۹.۸۳ to ۸۶, Mean ADL: ۶.۶ to ۲۷.۱, Mean ASES: ۲۸.۶ to ۸۸.۹) (P value<۰.۰۰۰۱). Conclusion: ORIF for neglected and displaced GT fractures has satisfactory functional outcomes, despite of non-anatomical reduction of the fracture.

Keywords:

nonunion , greater tuberosity , Reduction , Shoulder fractures