M.E.Müller: Atlas: Fracture 11-A1

Humerus, Proximal,
extra-articular fracture,
unifocal, tuberosity 0,37% of the total
5,18% of the humerus
12,65% of the segment

108 fractures
53,2% group
53%M, 47%F

73 fractures
36% group
52%M, 48%F

22 fractures
10,8% group
55%M, 45%F

Greater tuberosity,
not displaced Greater tuberosity,
displaced +Q With a glenohumeral dislocation +Q

These are fractures of the proximal humerus, extra-articular, unifocal, involving the greater tuberosity (A1) or the metaphyseal area that can be impacted (A2) or not (A3). The subgroups depend on the displacements. Ref. Manual of Internal Fixation:
184 - 187. 438 - 441.
Surgeon. RO.

As in the majority of the proximal humeral fractures, the generally prefered treatment is conservative. However, displaced fractures of the greater tuberosity in young patients, especially when associated to a shoulder dislocation, do have unequivocal surgical indication because a malunion of the greater tuberosity (proximal migration, subacromial) will interfere with the abduction.

Internal fixation is preferably performed with isolated lag screws, combined with a tension band, either with wires

or with non-resorbable sutures. The displaced metaphyseal fractures must be fixed with a plate, taking care of not disturbing the bicipital groove. The cloverleaf plate, with one leaf amputated, allows the placement of several 4.0 mm. cancellous screws into the humeral head. The T plate allows placing of 6.5 mm. screws but it is too thick and it allways interferes with the bicipital groove. A hook plate can be made by cutting and bending one end of a one-third tubular plate (see 11-B and 11-C).

preoperative

postoperative + 4 months + 1 year

preoperative preoperative preoperative

preoperative preoperative

+ 1 months + 1 months




						Humerus, Proximal, extra-articular fracture, unifocal, tuberosity	0,37% of the total 5,18% of the humerus 12,65% of the segment






These are fractures of the proximal humerus, extra-articular, unifocal, involving the greater tuberosity (A1) or the metaphyseal area that can be impacted (A2) or not (A3). The subgroups depend on the displacements.		Ref. Manual of Internal Fixation: 184 - 187. 438 - 441. Surgeon. RO.

As in the majority of the proximal humeral fractures, the generally prefered treatment is conservative. However, displaced fractures of the greater tuberosity in young patients, especially when associated to a shoulder dislocation, do have unequivocal surgical indication because a malunion of the greater tuberosity (proximal migration, subacromial) will interfere with the abduction. Internal fixation is preferably performed with isolated lag screws, combined with a tension band, either with wires	or with non-resorbable sutures. The displaced metaphyseal fractures must be fixed with a plate, taking care of not disturbing the bicipital groove. The cloverleaf plate, with one leaf amputated, allows the placement of several 4.0 mm. cancellous screws into the humeral head. The T plate allows placing of 6.5 mm. screws but it is too thick and it allways interferes with the bicipital groove. A hook plate can be made by cutting and bending one end of a one-third tubular plate (see 11-B and 11-C).