Déplacement secondaire après traitement orthopédique des fractures isolées du tubercule majeur : une étude des facteurs de risque portant sur 82 cas

Abstract Introduction The optimal treatment of isolated fractures of the greater tuberosity is an important topic of current surgical research. While non-displaced fractures are amenable to conservative treatment, displacement of the fragment can result in rotator cuff malfunction and impingement. For the present study, risk factors predicting secondary fragment displacement were analyzed. Hypothesis Certain risk factors determine a higher risk of secondary displacement in patients with greater tuberosity fractures. Patients and methods All patients diagnosed with a fracture of the greater tuberosity and initially treated non-surgically at our Level I trauma center between January 2008 and July 2015 were included in this retrospective analysis. Patients were grouped into: no secondary displacement (group 1) and secondary displacement at follow-up (group 2). The following risk factors were analyzed: age, gender, side of fracture, initial displacement, fragment/head-ratio, fragment shape, dislocation, concomitant fractures and concomitant fractures to the same extremity. Results Eighty-two patients (42 male, 40 female) were eligible for further analyses. Median follow up was 8.0 ± 39.5 days. Patients with secondary displacement (group 2) were significantly older (group 1: 51.7 ± 15.5, group 2: 68.3 ± 14.3; p p  = 0.024), whereas gender ( p  = 0.299), side of fracture ( p  = 0.189) and fragment/head ratio ( p  = 0.660) showed no significant different distribution between both groups. Finally, split-type fractures increased the risk of secondary displacement. Discussion The present study identified age older than 65 years to be an important risk factor for secondary displacement in the conservative management of fractures of the greater tuberosity. Furthermore, fracture type and shoulder dislocations are factors associated with an increased relative risk for secondary displacement. Level of Proof III, Retrospective comparative study.