Open Reduction Internal fixation of Incarcerated Greater Tuberosity Avulsion Fracture: A Case Report

Proximal humerus fractures are common injuries of the upper extremity. These fractures are frequent in the elderly population due to low-energy trauma and in the younger patient secondary to high-energy trauma that is associated with shoulder dislocations. Proximal humerus fractures are frequently classified according to the Neer classification which is defined by the number of segments and the amount displacement required to define the fracture as displaced. Segments include the greater tuberosity (GT), the lesser tuberosity, the humeral head, and the humeral shaft. Fractures are considered displaced if there is at least 45° of angulation or 1 cm of displacement.

We present a case of a 42-year-old Caucasian patient with a displaced and incarcerated GT avulsion fracture following a motorcycle accident. In this report, we describe the patient positioning, technique using open reduction internal fixation utilizing multiple anchors and suture to treat this injury and the successful outcome of our patient 1 year from the injury.

While standard open reduction internal fixation techniques using plates and screws are appropriate for treating these injuries, we chose to pursue a method that involved only bio-absorbable suture anchors. Using these anchors, we were able to achieve an anatomic reduction of the GT fragment that ultimately went on to achieve full healing.