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Orthopedic Research Online Journal

Isolated Fracture of the Lesser Tuberosity, A Case Report and Literature Review

  • Open or CloseAlex N Karanja*, Andrew P McBride and Michael J Thomas

    Department of Orthopaedic Surgery, Hand and Upper Limb Unit, Gold Coast University Hospital, Australia

    *Corresponding author: Alex Ngatia Karanja, Department of Orthopaedic Surgery, Hand and Upper Limb Unit, Gold Coast University Hospital, 1 Hospital Blvd, Southport, 4215, Queensland, Australia.

Submission: July 08, 2022Published: July 20, 2022

DOI: 10.31031/OPROJ.2022.09.000722

ISSN : 2576-8875
Volume9 Issue5


Background: Isolated fracture of the lesser tuberosity of the humerus is a rare injury that is commonly missed at initial presentation with a third of known cases having a delayed diagnosis. The purpose of this article is to report a case of an isolated lesser tuberosity fracture that was initially misdiagnosed in the emergency department of a metropolitan hospital and then surgically fixed with a novel technique. We also present a review of the literature and propose a new diagnostic algorithm for the initial assessment and management of this injury.

Case presentation: A 35-year-old male, left-hand-dominant carpentry student, presented to the emergency department of a metropolitan hospital with left shoulder pain after a fall off a skateboard. He was misdiagnosed with a soft tissue injury and discharged with a sling and simple analgesia after an anteroposterior (AP) radiograph failed to demonstrate the fracture. He represented two days later when orthopaedic examination revealed a positive Napoleon sign, further imaging including a lateral radiograph and subsequent CT and MRI imaging demonstrated a lesser tuberosity avulsion fracture. His fracture was fixed with four bioabsorbable suture anchors with a double row suture bridge technique. At 6 months post-operative he achieved a constant shoulder score of 70, a range of motion including 145 degrees abduction, 150 degrees flexion and internal rotation to T12. He had no limitations to his daily activities.

Conclusion: Our case, in addition to a literature review, reveals that a high clinical index of suspicion in patients presenting with shoulder pain after specific mechanisms of injury and a positive belly press sign on examination combined with special x-ray views and axial imaging can reduce the incidence of missed isolated lesser tuberosity fractures. The literature suggests that acute cases in younger patients should be managed operatively while a trial of econservative treatment in chronic cases is appropriate. These findings are summarised in our newly proposed diagnostic and management algorithm.

Keywords:Shoulder surgery; Isolated fracture; Lesser tuberosity

Abbreviations: AP: Anteroposterior; LT: Lesser Tuberosity; MRI: Magnetic Resonance Imaging; CT: Computed Tomography; T12: Twelfth Thoracic Vertebra

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