71.10 Fracture of the greater tuberosity

The greater tuberosity of a patient’s humerus can be fractured by a direct blow, or it can be torn off when he dislocates it. Treatment depends on how far displaced the fragment is.

Figure 71.10: FRACTURE OF THE GREATER TUBEROSITY. Infiltrate the fracture site with local anaesthetic. Abduct the patient’s arm (1), and press firmly on the fragment with your thumb (2), continue to press on the fragment while you lower his arm (3), so that it stays in place while you do so. After de Palma, with kind permission.

FRACTURES OF THE GREATER TUBEROSITY

MINIMAL DISPLACEMENT Begin active shoulder, elbow, and finger movements immediately. If necessary give the patient a sling for a few days.

MORE THAN MINIMAL DISPLACEMENT Try the following methods in this order, until you find one which works.

First try abducting the patient’s arm. This will cause the fragment to press against the under–side of his acromion and may push it into place. If this fails try the method in Fig. 71-10.

If reduction is successful, put his arm in a sling and encourage active movements.

If reduction fails, repeat it again 2 weeks later, when the fragment will have become ’sticky’ if this too fails, and abduction is severely limited, refer him for operative treatment. Meanwhile encourage active movements, as above.