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Abstract: A fracture of the greater tuberosity of the humerus is caused by sudden violence of the shoulder joint, such as violent abduction of the shoulder joint, direct violence or dislocation of the shoulder joint, while this patient was playing badminton, a violent abduction action of the shoulder joint occurred resulting in a fracture of the greater tuberosity of the humerus, which was finally confirmed by taking radiographs. An incisional internal fixation was taken to restore the stability of the fracture end and to promote smooth healing of the fracture.
Basic information】Female, 44 years old
Type of disease】Humeral tuberosity fracture
Hospital】Harbin First Hospital
Date of consultation】July 2021
Treatment plan]: Incisional internal fixation + forearm sling suspension fixation + rehabilitation training
Treatment Period】7 days of hospitalization, 1 month of outpatient follow-up
Results】Fracture repositioning and fixation, pain relief
I. Initial consultation
The patient was admitted to the hospital with severe localized pain and was immediately given X-rays to confirm the specific site of the fracture and the degree of fracture displacement. The initial diagnosis was a fracture of the greater tuberosity of the humerus. After the fracture occurred, due to the pulling of the supraspinatus muscle, the greater tuberosity of the humerus was displaced upward and backward. The displacement of the greater tuberosity fracture will continue to aggravate, which will affect the shoulder joint supination activity and cause the rotator cuff muscles to relax and weaken. Due to the significant displacement of the greater tuberosity, in order to avoid subacromial impingement after the fracture heals and affects rotator cuff function, we recommend that the patient consider surgery to restore the stability of the greater tuberosity fracture and to protect the function of the shoulder joint.
II. Treatment history
After communication with the patient’s family, the patient and family agreed to perform an incision and internal fixation. During the operation, it was confirmed that the humeral greater tuberosity fracture was displaced and the stability of the fracture end was poor, and the rotator cuff muscles and tendons were flaccid and weak. The humeral tuberosity fracture site was re-fixed with internal fixation screws to ensure the tension of the rotator cuff muscles and tendons. After fixation, it was confirmed that the abductor shoulder joint was not subacromial impingement and the fracture end did not become loose. The fracture site was kept in a low tension state by using a forearm sling for postoperative suspension. At the same time, the patient was instructed to start postoperative rehabilitation training, with passive shoulder abduction and forward flexion and supination by a rehabilitator to prevent joint adhesions and joint stiffness.
III. Treatment effect
The patient’s shoulder joint pain and swelling were relieved, and the range of motion of the shoulder joint was significantly improved. The patient was discharged at 7 days of hospitalization, and at the follow-up outpatient visit one month later, the patient was able to move his fingers, wrist and elbow joints freely, and the blood supply to the fracture end was accelerated through muscle contraction and diastole training of the upper limbs, which promoted the gradual healing of the humeral tuberosity fracture and effectively restored the function of the shoulder joint.
IV. Precautions
After the surgery, the patient’s condition is more stable. After discharge from the hospital, it is necessary to pay attention to keep the upper limb suspended and fixed at all times, and pay attention to review the X-ray film at the hospital regularly. After confirming that there is continuous bone scab at the fracture end of the greater tuberosity of the humerus and that the fracture stability has been significantly improved, the sling fixation can be removed and the patient can gradually resume daily life. In addition, the patient is advised not to put weight on the shoulder joint and upper limb until the fracture is completely healed, as this may cause re-displacement of the humeral tuberosity fracture site, which may affect the smooth healing of the fracture and may result in loosening or breaking of the internal fixation screws, leading to surgical failure. While strengthening nutrition, the patient needs to insist on making fist every day to promote blood circulation in the upper limb to speed up the smooth healing of the fracture.
V. Personal insight
After surgery, forearm sling fixation and rehabilitation, the fracture healed effectively. Therefore, we would like to remind you that after a humeral greater tuberosity fracture, you should pay attention to the radiographs to confirm the displacement of the fracture end, if the degree of displacement is obvious, it is usually necessary to consider that there is rotator cuff pulling, which can easily induce the later subacromial impingement and lead to the limitation of shoulder joint movement. If there is anterior dislocation of the shoulder joint, the humeral head should be repositioned first and then the greater tuberosity of the humerus should be repositioned. If there is still significant displacement, surgical reduction and internal fixation is required.