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Abstract: A 65-year-old woman who did not hold the bus steady when it braked sharply and fell caused a fracture of the greater tuberosity of the humerus and had difficulty moving the shoulder joint after the injury. After surgical treatment, the patient recovered well from the fracture and the shoulder joint returned to normal function. The greater tuberosity of the humerus is a bony bump on the outside of the proximal humerus that can be felt with the hand under normal circumstances, and there are many tendons in the shoulder joint that attach to the greater tuberosity of the humerus; therefore, when the shoulder is injured it can easily lead to a fracture of the greater tuberosity of the humerus.
Basic information】Female, 65 years old
Disease Type】Humeral tuberosity fracture
Hospital】The First Hospital of Harbin Medical University
Date of Consultation】November 2021
Treatment plan】Surgical treatment (fracture incision and internal fixation)
Treatment Period】Inpatient treatment for 14 days, postoperative review for 3 and 6 months
Results】The fracture healed and the shoulder joint movement returned to normal.
I. Initial consultation
The patient came to the hospital emergency room after the injury. After taking a detailed history, we learned that the patient had accidentally fallen during emergency braking and had developed shoulder pain, swelling and inability to move after the injury, so she decided to come to the hospital for examination. After preliminary examination, it was found that there was a pressure point on the lateral side of the patient’s shoulder, along with weakness in shoulder abduction. Subsequently, a radiographic examination was performed, and from the film it was seen that a fracture mass existed on the lateral side of the patient’s proximal humerus that was significantly separated from the main stem. Therefore, based on the patient’s history, signs and imaging examination, the diagnosis of a humeral greater tuberosity fracture was confirmed.
II. Treatment history
After admission, the patient underwent CT examination of the shoulder joint in order to further observe the morphology of the fracture and decide on the surgical plan, and to improve routine preoperative tests such as routine blood, liver and kidney functions, electrocardiogram, and chest X-ray. On the 3rd day after admission, the patient underwent an incisional internal fixation of the fracture under general anesthesia. During the operation, the avulsed fracture was repositioned using an internal fixation plate, which fixed the avulsed fracture block and also repaired the damaged ligaments together. After surgery, the incision was regularly cared for, and the shoulder joint was braked in the abducted position during the day and needed to be raised above the head during sleep at night.
III. Treatment results
After the surgery, the patient’s shoulder pain was significantly relieved and the mobility returned to normal. On the second day after the surgery, the patient was given a shoulder joint external booth brace for immobilization, and the upper limb was mildly swollen, and the other joints of the upper limb moved freely. On the 14th day of hospitalization, the shoulder joint gradually began to function and gradually fell back from the external booth until the normal position was restored, but the patient felt weakness in active abduction during activities, and was discharged home to recuperate. Three months after surgery, the fracture healed well and the shoulder joint was actively abducted without pain.
IV. Precautions
We are glad that the patient recovered from the fracture after the treatment, but we suggest that the patient needs to review the X-ray regularly after the surgery to observe the fracture healing. During the period of braking with the shoulder abduction frame, muscle contraction exercises and other joint activities of the upper limb need to be strengthened to avoid joint stiffness and muscle atrophy. After the abduction frame is removed, the shoulder joint needs to gradually practice active abduction ability. Before the fracture heals, the patient should avoid weight-bearing on the abducted shoulder joint. After the fracture heals, the shoulder joint should be strengthened to prevent adhesions. During the fracture healing period, the diet should be increased with calcium-rich foods such as soy products and milk products to promote fracture healing. At 1-1.5 years after surgery, the internal fixation can be removed, but if the patient does not feel discomfort, it can be kept in the body.
V. Personal insight
For a nondisplaced humeral greater tuberosity fracture, the patient can be treated conservatively, i.e., with a combined shoulder dislocation, and after resetting the dislocation, it can also be treated conservatively by suspension with a triangular scarf for 2-3 weeks. However, if the fracture is obviously separated and displaced, as in this case, it is difficult to reset the fracture manually, which means that the patient has serious injury to the shoulder joint, surrounding soft tissues, and rotator cuff.