Scientific Articles   |    
Fractures of the Lesser Tuberosity of the Humerus
C. Michael Robinson, BMedSci, FRCSEd(Orth)1; Kar H. Teoh, MB ChB1; Alex Baker, MRCSEd1; Lawrence Bell, MB ChB1
1 The New Royal Infirmary of Edinburgh,Old Dalkeith Road, Edinburgh EH16 4SU, United Kingdom. E-mail address for C.M. Robinson: c.mike.robinson@ed.ac.uk
View Disclosures and Other Information
Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.
Investigation performed at The Shoulder Injury Clinic, Edinburgh Orthopedic Trauma Unit, The New Royal Infirmary of Edinburgh, Edinburgh, United Kingdom

The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2009 Mar 01;91(3):512-520. doi: 10.2106/JBJS.H.00409
5 Recommendations (Recommend) | 3 Comments | Saved by 3 Users Save Case


Background: Fractures of the lesser tuberosity are rare injuries, and little is known of their epidemiology. Operative treatment is generally recommended for displaced fractures; however, the outcome of this method of treatment has not previously been studied. The aims of our study were to determine the approximate incidence of lesser tuberosity fractures, as well as the functional outcome following operative treatment in a consecutive series of patients.

Methods: Over an eight-year period, we studied the demographic details of a consecutive series of twenty-two adult patients who had a fracture of the lesser tuberosity. We used age and sex-specific local census data to estimate the annual incidence of this injury in our local population. Seventeen of the original cohort of twenty-two patients, who were medically fit and had a displaced (two-part) fracture, were treated with open reduction and internal fixation of the fracture. We assessed the outcome using the Short Form-36 (SF-36) general health measure, the Constant score, and the Disabilities of the Arm, Shoulder and Hand (DASH) score.

Results: The estimated annual incidence of these fractures was low at 0.46 per 100,000 population per year during the study period. There were fifteen men and seven women, with a median age of forty-three years. There was an even distribution of fractures across the age cohorts, and most fractures were sustained from a high-energy transfer mechanism. The median Constant score was 95 points at two years, and the median DASH score was 12 points at two years after the injury. Most patients regained nearly normal range of motion in the affected shoulder by three months. One patient had development of posttraumatic shoulder stiffness, which responded to arthroscopic release. All patients who were in regular employment prior to the injury returned to their jobs within six months. There were no significant differences between each component of the SF-36 at two years compared with age and sex-matched controls.

Conclusions: A lesser tuberosity fracture, without an associated humeral head or greater tuberosity fracture, is a rare injury. Open reduction and internal fixation provides excellent restoration of function and range of shoulder movement, with a low risk of complications.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

Figures in this Article
    Sign In to Your Personal ProfileSign In To Access Full Content
    Not a Subscriber?
    Get online access for 30 days for $35
    New to JBJS?
    Sign up for a full subscription to both the print and online editions
    Register for a FREE limited account to get full access to all CME activities, to comment on public articles, or to sign up for alerts.
    Register for a FREE limited account to get full access to all CME activities
    Have a subscription to the print edition?
    Current subscribers to The Journal of Bone & Joint Surgery in either the print or quarterly DVD formats receive free online access to JBJS.org.
    Forgot your password?
    Enter your username and email address. We'll send you a reminder to the email address on record.

    Forgot your username or need assistance? Please contact customer service at subs@jbjs.org. If your access is provided
    by your institution, please contact you librarian or administrator for username and password information. Institutional
    administrators, to reset your institution's master username or password, please contact subs@jbjs.org


    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
    CME Activities Associated with This Article
    Submit a Comment
    Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
    Comments are moderated and will appear on the site at the discretion of JBJS editorial staff.

    * = Required Field
    (if multiple authors, separate names by comma)
    Example: John Doe

    Related Content
    The Journal of Bone & Joint Surgery
    JBJS Case Connector
    Topic Collections
    Related Audio and Videos
    Clinical Trials
    Readers of This Also Read...
    JBJS Jobs
    Connecticut - Yale University School of Medicine
    Illinois - Hinsdale Orthopaedics
    Oregon - The Center - Orthopedic and Neurosurgical Care and Research