Le fratture delle tuberosità omerali: diagnosi e principi di trattamento

Despite the relatively common occurence of fractures of the proximal humerus in the elderly, the subgroup of isolated fractures of the greater and lesser tuberosity is still less well understood. Isolated tuberosity fractures are commonly associated with gleno-humeral dislocation or direct impact to the shoulder region. The diagnosis of greater tuberosity fracture is fairly commonly missed or ignored and this can result in an unaccettable treatment outcome. A standard radiographic trauma series of the shoulder must be obtained, including a true AP view in intrarotation and extrarotation. CT scans with coronal, sagittal and 3D reconstruction are useful for planning the surgical approach. Conservative treatment is recommended in non displaced and minimally displaced cases (5 mm in a high-demanding patient,10 mm in a low-demanding patient). The treatment of displaced fractures includes both arthroscopically assisted fixation and open reduction and internal fixation with screws or tension banding sutures. The choice of approach depends not only on fracture type but also on patient-related factors and the surgeon’s experience.