Proximal Humerus Fracture/Dislocation: Look for the Greater Tuberosity.

Area of Science:

• Orthopedic Surgery
• Traumatology
• Radiology

Background:

• Shoulder dislocations frequently involve fractures of the surgical neck or greater tuberosity.
• Successful functional recovery hinges on the union of the greater tuberosity fragment, crucial for rotator cuff tendon insertion.

Observation:

• A patient with shoulder fracture dislocation presented with an axillary nerve injury.
• Initial post-reduction radiographs in the Emergency Department suggested satisfactory fracture alignment.
• A subsequent CT scan revealed significant displacement of the greater tuberosity, missed on initial X-rays.

Findings:

• Greater tuberosity fractures can be deceptively reduced on initial post-reduction radiographs, especially with single-view imaging.
• The 'disappearing tuberosity' sign on plain radiographs warrants further investigation with CT.
• CT imaging is essential for accurate assessment of greater tuberosity displacement.

Implications:

• Misinterpretation of post-reduction radiographs can lead to delayed or inadequate treatment.
• Prompt surgical fixation with a locking plate and suture construct is necessary for displaced fractures.
• Emphasizes the importance of advanced imaging (CT) for complex shoulder injuries to ensure optimal patient outcomes.