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Greater tuberosity medial malposition: does it affect shoulder abductor moment?
Taner Bekmezci1, Serdar Kamil Çepni2, Tuğcan Demir3
1Physiotheraphy and Rehabilitation Department, T.C. Istanbul Yeni Yüzyıl University Faculty of Health Sciences, Maltepe Mahallesi, Yılanlı Ayazma Caddesi, No: 26 P.K. 34010 Cevizlibağ, Zeytinburnu, İstanbul, Turkey. tanerbekmezci@hotmail.com.
International Orthopaedics
|September 5, 2023
Summary
Medialization of the greater tuberosity after proximal humerus fracture fixation can decrease functional scores by shortening the rotator cuff moment arm. This finding is similar to superior or posterior malpositions and warrants clinical consideration.
Area of Science:
- Orthopedic Surgery
- Biomechanics
- Traumatology
Background:
- Greater tuberosity malposition negatively impacts functional outcomes after proximal humerus fractures.
- Superior or posterior malpositions exceeding 5 mm increase deltoid loading.
- The effect of medialization of the greater tuberosity due to locking plate fixation, particularly in fractures with metaphyseal dead space, is under-investigated.
Purpose of the Study:
- To investigate the hypothesis that medialization of the greater tuberosity may shorten the rotator cuff moment arm.
- To evaluate the impact of medial greater tuberosity displacement on functional scores in proximal humerus fractures treated with locking plates.
Main Methods:
- A retrospective study of 52 patients (mean age 65.28 years) with proximal humerus fractures treated with locking plate fixation between 2012 and 2018.
- Evaluation of cephalodiaphyseal angle, greater tuberosity displacement, patient-reported outcomes, and Constant-Murley scores.
- Statistical analysis including Kruskal-Wallis test to compare fracture types.
Main Results:
- Mean Constant-Murley score was 78.76; patient-reported outcomes included 39 excellent, 5 good, 2 fair, and 6 poor results.
- Greater tuberosity displacement ranged from 6 mm posterior-superior to -13 mm medial, with significant medialization observed in three patients.
- Weak correlations were found between cephalodiaphyseal angle, greater tuberosity medialization, and functional scores; Neer types 3 and 4 fractures differed significantly from type 2.
Conclusions:
- Medial impaction of the greater tuberosity is a potential cause of decreased functional scores, analogous to superior or posterior malpositions.
- Greater tuberosity medialization should be considered a contributing factor to rotator cuff abductor moment arm shortening.
- Further research is needed to fully elucidate the clinical implications of medial greater tuberosity displacement.
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