Incidence
Approximately 20% of all surgical neck of humerus fractures
Seen in approximately 15% of anterior shoulder dislocations
Mutch Classification
| Type A: Avulsion | Type B: Depression | Type C: Split |
|---|---|---|
| Horizontal fracture line | Fragment compressed inferiorly | Vertical fracture line |
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Xray / CT
Deforming force - rotator cuff displaces superiorly (supraspinatus) and posteriorly (infraspinatus)
Look for occult surgical neck of humerus fractures
MRI
Displaced GT fracture with torn rotation cuff seen on sagittal MRI
Nonoperative management
Indications
Minimally displaced fragments
Secondary fracture displacement
Cirigliano et al JSES Int 2024
- 29 cases of anterior GHJ dislocation with GT fracture
- treated nonoperative
- 24% of fractures underwent secondary displacement requiring surgery
- all comminuted fractures
- other patients did well
Operative management
Issues
Displaced fragments cause impingement
Associated with rotator cuff tears
Indications
> 5 mm in older, sedentary patients
> 3 mm in younger, active patients
Options
Open v arthroscopic
Fixation techniques
- screw fixation - young patients
- suture fixation and screw post - elderly
- hook plates
- locking plates
Results
Open
- 29 patients with open screw and washer fixation isolated GT fracture
- all united by 3 months
- 31% had postoperative stiffness requiring arthroscopic release
Arthroscopic versus open
- 79 patients with isolated GT fractures
- 53 open treatment and 26 arthroscopic treatment
- all united by 3 months
- no difference between groups
Huntley et al Orthop Traumatol Surg 2020
- systematic review of open v arthroscopic fixation
- no difference in functional outcomes
- complications: open 23%, arthroscopic 7%
Open technique
Deltoid split
AO Surgery reference deltoid split PDF
Small fragments
- deltoid splitting approach
- double row anchor repair
- suture fragment and repair over distal screw post
Large fragments
- deltoid splitting approach / deltopectoral approach
- screw fixation
- plate fixation
Screw and washer fixation young patient
Suture fixation over screw post in elderly patient
Arthroscopic technique
Technique
Double row suture anchor technique
Arthroscopic techniques suture bridge fixation surgical technique PDF
Vumedi arthroscopic greater trochanter repair video
Greater tuberosity malunion
Technique
Vumedi open greater tuberosity malunion video