Quantitative 3-dimensional Computerized Tomography Modeling of Isolated Greater Tuberosity Fractures with and without Shoulder Dislocation

Document Type : RESEARCH PAPER


1 Department of General Surgery, OLVG, Amsterdam, The Netherlands

2 Orthopaedic Hand and Upper Extremity Service, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA

3 Department of Orthopaedic Surgery, OLVG, Amsterdam, The Netherlands

4 Department of Surgery, Dell Medical School, University of Texas, Austin, TX, USA


Background: The aim of this study was to assess differences in fracture morphology and displacement between
isolated greater tuberosity (GT) fractures (i.e. fractures of the greater tuberosity without other fractures of the proximal
humerus) with and without shoulder dislocation utilizing quantitative 3-dimensional CT imaging.
Methods: Thirty-four CT-scans of isolated greater tuberosity fractures were measured with 3-dimensional modeling.
Twenty patients (59%) had concomitant dislocation of the shoulder that was reduced prior to CT-scanning. We
measured: degree and direction of GT displacement, size of the main fracture fragment, the number of fracture
fragments, and overlap of the GT fracture fragment over the intact proximal humerus.
Results: We found: (1) more overlap –over the intact humerus– in patients without concomitant shoulder dislocation
as compared to those with shoulder dislocation (P=0.03), (2) there was a trend towards greater magnitude of
displacement between those without (mean 19mm) and those with (mean 11mm) a concomitant shoulder dislocation
(P=0.07), and (3) fractures were comparable in direction of displacement (P=0.50) and size of the fracture fragment
Conclusion: We found substantial variation in degree and direction of displacement of GT fracture fragments. Variation
in degree of overlap and displacement is partially explained by concomitant shoulder dislocation.
Level of evidence: IV


Main Subjects

1. Mattyasovszky SG, Burkhart KJ, Ahlers C, Proschek
D, Dietz SO, Becker I, et al. Isolated fractures of the
greater tuberosity of the proximal humerus: a longterm
retrospective study of 30 patients. Acta Orthop.
2011; 82(6):714-20.
2. Gruson KI, Ruchelsman DE, Tejwani NC. Isolated
tuberosity fractures of the proximal humeral: current
concepts. Injury. 2008; 39(3):284-98.
3. Green A, Izzi J Jr. Isolated fractures of the greater
tuberosity of the proximal humerus. J Shoulder Elbow
Surg. 2003; 12(6):641-9.
4. Neer CS 2nd. Displaced proximal humeral fractures.
I. Classification and evaluation. J Bone Joint Surg Am.
1970; 52(6):1077-89.
5. Bigliani LU, Pollock RG. Fractures of the proximal
humerus. Philadelphia: WB Saunders; 1998.
6. Bono CM, Renard R, Levine RG, Levy AS. Effect of
displacement of fractures of the greater tuberosity on
the mechanics of the shoulder. J Bone Joint Surg Br.
2001; 83(7):1056-62.
7. Gerber C, Warner JJ. Alternatives to hemiarthroplasty
for complex proximal-humeral fractures. Philadelphia:
Lippincott-Raven; 1997. P. 215-43.
8. McLaughlin HL. Dislocation of the shoulder with
tuberosity fracture. Surg Clin North Am. 1963;
9. Paavolainen P, Bjorkenheim JM, Slatis P, Paukku P.
Operative treatment of severe proximal humeral
fractures. Acta Orthop Scand. 1983; 54(3):374-9.
10. Park TS, Choi IY, Kim YH, Park MR, Shon JH, Kim SI.
A new suggestion for the treatment of minimally
displaced fractures of the greater tuberosity of the proximal humerus. Bull Hosp Jt Dis. 1997; 56(3):171-6.
11. Platzer P, Kutscha-Lissberg F, Lehr S, Vecsei V, Gaebler
C. The influence of displacement on shoulder function
in patients with minimally displaced fractures of the
greater tuberosity. Injury. 2005; 36(10):1185-9.
12. Depalma AF, Cautilli RA. Fractures of the upper end of
the humerus. Clin Orthop. 1961; 20(1):73-93.
13. Foruria AM, de Gracia MM, Larson DR, Munuera L,
Sanchez-Sotelo J. The pattern of the fracture and
displacement of the fragments predict the outcome
in proximal humeral fractures. J Bone Joint Surg Br.
2011; 93(3):378-86.
14. Ogawa K, Yoshida A, Ikegami H. Isolated fractures
of the greater tuberosity of the humerus: solutions
to recognizing a frequently overlooked fracture. J
Trauma. 2003; 54(4):713-7.
15. Braunstein V, Wiedemann E, Plitz W, Muensterer OJ,
Mutschler W, Hinterwimmer S. Operative treatment
of greater tuberosity fractures of the humerus--a
biomechanical analysis. Clin Biomech (Bristol, Avon).
2007; 22(6):652-7.
16. Castagno AA, Shuman WP, Kilcoyne RF, Haynor DR,
Morris ME, Matsen FA. Complex fractures of the
proximal humerus: role of CT in treatment. Radiology.
1987; 165(3):759-62.
17. Yin B, Moen TC, Thompson SA, Bigliani LU, Ahmad
CS, Levine WN. Operative treatment of isolated
greater tuberosity fractures: retrospective review of
clinical and functional outcomes. Orthopedics. 2012;
18. Bahrs C, Lingenfelter E, Fischer F, Walters EM,
Schnabel M. Mechanism of injury and morphology 
of the greater tuberosity fracture. J Shoulder Elbow
Surg. 2006; 15(2):140-7.
19. Dimakopoulos P, Panagopoulos A, Kasimatis G,
Syggelos SA, Lambiris E. Anterior traumatic shoulder
dislocation associated with displaced greater
tuberosity fracture: the necessity of operative
treatment. J Orthop Trauma. 2007; 21(2):104-12.
20. Kim E, Shin HK, Kim CH. Characteristics of an isolated
greater tuberosity fracture of the humerus. J Orthop
Sci. 2005; 10(5):441-4.
21. Brouwer KM, Bolmers A, Ring D. Quantitative
3-dimensional computed tomography measurement
of distal humerus fractures. J Shoulder Elbow Surg.
2012; 21(7):977-82.
22. Guitton TG, van der Werf HJ, Ring D. Quantitative threedimensional
computed tomography measurement of
radial head fractures. J Shoulder Elbow Surg. 2010;
Volume 7, Issue 1
January and February 2019
Pages 24-32
  • Receive Date: 28 November 2017
  • Revise Date: 01 August 2018
  • Accept Date: 04 August 2018