Radiographic appearance of displaced lesser tuberosity osteotomy: a case series

Lesser tuberosity osteotomy has become a popular method of subscapularis management during total shoulder arthroplasty with high healing rates and reliable functional recovery. One major advantage of this technique is the ability to monitor healing using routing radiographs. Recognition of displacement of the lesser tuberosity may provide a unique opportunity for revision repair before the tuberosity becomes irreversibly retracted.

A series of four patients were identified with a displaced lesser tuberosity osteotomy following total shoulder arthroplasty. Radiographs from these patients were reviewed to identify the optimal radiograph for detecting displacement.

In each of the four cases, the displaced lesser tuberosity osteotomy was not seen on the axillary radiograph. A true AP radiograph consistently provided the only clear view of the displaced osteotomy. CT or MRI was used to confirm displacement of the lesser tuberosity osteotomy. In each case, displacement of the lesser tuberosity resulted from either a traumatic event, or from patient non-compliance with post-operative restrictions.

This is the first report that characterizes the radiographic appearance of failure of the lesser tuberosity osteotomy technique. Displacement of lesser tuberosity osteotomy following shoulder arthroplasty is best observed using a true AP radiograph.