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Isolated Displaced Fracture of the Lesser Tuberosity

Oburu E1, John J2,

  1. School of Medicine, University of Nairobi

  2. Department of Trauma and Orthopaedic Surgery, Hairmyres Hospital, East Kilbride, UK

Correspondence to: Dr. Ezekiel Oburu. P.O. Box 2206  00100, Nairobi. Email: oburue@googlemail.com

Summary

Isolated displaced fracture of the lesser tuberosity of the humerus is unusual. These injuries may be difficult to diagnose and can be easily missed. We present a 53 year old patient who sustained this injury and at initial evaluation it was missed. However, careful review of his X rays and CT Scans revealed the fracture. Fixation of the fracture was achieved with two cancellous screws. Diagnosis of this fracture will be aided by a high index of suspicion.

 

Key Words: Lesser tuberosity, Proximal humerus, Two-part fracture

Introduction

Isolated lesser tuberosity fractures of the humerus are rare (1). These injuries can easily be missed and as a result of this, a number of cases that have been reported usually present with chronic shoulder pain (2). A high index of suspicion will aid in diagnosis of this injury (3).

 

Case Report

A 53 year old man slipped backwards down the stairs holding onto banisters with his left hand. This resulted in a painful left shoulder which was assessed in the Accident and Emergency (A&E) department clinically and radiographically. A bony injury was not recognised at that time and a radiographic abnormality on the antero-posterior (AP) film was dubbed to be an “artefact” (figure 1). The patient was advised that he had soft tissue injury of the shoulder and was to be managed conservatively.

 

The radiographs were reviewed by a radiologist in whose opinion the ‘artefact’ was a displaced lesser tuberosity fracture of the left humerus (Figure 1). Further review in the consultant clinic revealed extensive bruising over the anterior aspect of the left shoulder and also within the axilla. There was also difficulty in internal rotation and abduction of the left arm. A computerised tomography scan (CT) of the shoulder was performed which clearly showed the isolated fragment of the lesser tuberosity (Fi