ISOLATED AVULSION FRACTURE OF THE LESSER TUBEROSITY OF THE HUMERUS - A CASE-REPORT

Purpose of the study The authors report a rare case of an isolated avu lsion fracture of the lesser tuberosity of the humerus in an adult. Th e aim of the study was to highlight diagnostic features as well as sur gical treatment. Material: A 31 year old woman presented an isolated a vulsion fracture of the lesser tuberosity of the humerus. Physical exa m, standard radiographs of the shoulder as well as a computed tomograp hies (CT) were obtained. Methods: An assessment was made of the patien t's complaints, signs and symptoms, diagnosis, surgical treatment, phy sical therapy and follow-up. Final clinical results were evaluated acc ording to external rotation and muscular strength of the shoulder. Res ults: The diagnosis was evoked on standard radiographs of the shoulder and confirmed by CT. The patient was operated on the 8th day followin g trauma and pendular physical therapy was initiated on the third day postoperatively. The patient recovered her daily activities from the 6 th week and was back at work by the end of the 2nd month. Follow up at 12 months showed a painless shoulder with external rotation at 50 deg rees in adduction and 70 degrees in abduction. Muscular strength was i dentical to the contralateral side. No antero-medial impingement was d etected due to the hardware. Discussions This observation illustrates the rare aspect of this fracture already recognized in literature. The fracture mecanism remains unknown. We agree with Haas, Ross and Love that it might be due to a forced external rotation of the shoulder at 60 degrees of abduction. We highlight the role of the ''axillary view' ' and of the magnetic resonance imaging (MRI) in the diagnostic approa ch. Treatment is surgical by open reduction and internal fixation of t he detached fragment. Conclusion: Treatment must be surgical whenever there is a slight displacement of the detached fragment, to prevent no n union, mal union or an antero-medial impingement that might limit mo bility and muscular strength.