Unstable Fractures of the Greater Tubercle of the Humerus. A Case Report

The paper presents the results of stabilization of an unstable, comminuted fracture of the greater tubercle with absorbable sutures after fixation of a comminuted fracture of the proximal humerus with a reconstructive nail. This unusual procedure was performed upon ascertaining an anatomical reconstruction of the humeral head fragments and mechanical efficiency of the intramedullary nail fixation.Stabilization was performed with absorbable sutures through an extended surgical approach that allowed anchoring the unstable fragments of the greater tubercle to the shaft. The resulting anatomical positioning was additionally reinforced with screws locking the nail in its proximal end. After the procedure, a Dessault orthosis was used for 3 weeks, with intensive rehabilitation afterwards. A final assessment was made one year after the injury. It was based on the patients subjective feelings, the quality of bone union and fragment repositioning, estimated range of motion and limb function with Constant-Murley and QuickDash scores.An excellent treatment result was obtained. The anatomical position and shoulder function was fully restored. The patient reported no pain and no limb dysfunction.Based on these results we concluded that an open reduction and suturing of the unstable bone fragments of the greater tubercle with absorbable sutures allows anatomical repositioning and sufficient stabilization after intramedullary nailing. It may serve as an alternative to the conversion from intramedullary nailing to plate fixation in cases similar to ours.