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Lesser Tuberosity Fractures

- See: Fracture Dislocation:

- Discussion:
    - pure avulsions of the lesser tuberosity are rare;
    - pressence of this frx raises possibility of assoicatted posterior dislocation;
    - lesser tuberosity fragment consists of the lesser tuberosity with its attached subscapularis muscle;
    - avulsion of this frag may allow undue external rotation of humeral neck frx;
    - two part lesser tuberosity frx are usually associated w/ posterior glenohumeral dislocation;
    - small fragments can be treated without surgery;
    - three part lesser tuberosity fractures:
         - greater tuberosity is attached to the head;
         - lies in internal rotation: articular surface faces posteriorly;
         - shaft is pulled medially by the pectoralis major;
         - long head of biceps may also be caught between fragments which obstructs reduction;

- Radiographs:
    - attempt to get Axillary View since it is not only diagnostic of shoulder dislocation but also allows assessment of humeral head compression frx, glenoid frx, & lesser tuberosity frx of the humerus;

- Surgical Treatment: Two Part Frx:
    - dynamic compression: either by tension band stabilization or incorporation of tuberosity fragment in a tension band plate;
    - occassionally, cancellous lag screws with washers may be used to achieve stable fixation;
    - rare frx, which may be assoic w/ posterior dislocation frx;
    - if this frx is small and does not block medial rotation, successful treatment by closed  reduction is possible;
    - displacement of tuberosity & attached subscapularis insertion in absence of assoc dislocation rarely results in functional deficit

Year Book: Open Reduction and Internal Fixation of Two-Part Displaced Fractures of the Greater Tuberosity of the Proximal Part of the Humerus.

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