A Retrospective Study On Morphological Classification For Greater Tuberosity Fractures Of The Proximal Humerus

Objective To guide the clinical treatment of greater tuberosity fractures of proximal humerus by retrospectively categorizing greater tuberosity fractures based on the morphologic classification proposed by J. Mutch in 2014 and analyzing the treatment effects and postoperative recovery situation of patients’ shoulder function.Methods All patients with greater tuberosity of humerus, who were treated in the Department of Orthopedics of Tangshan Second Hospital from January 2009 to January2014 were retrospectively analyzed. All of them had an AP X-ray of shoulder joint and some had a 3D reconstruction CT.A total of 100 patients were screened in accordance with the relevant inclusion criteria and morphologic classification of greater tuberosity fracture criteria. Of them, typeⅠ39 patients, including 23 cases of surgical treatment and7 cases of shoulder dislocation; typeⅡ 44 cases, including 26 cases of surgical treatment and 10 cases of shoulder dislocation; type Ⅲ 17 cases, conservative treatment and 9 cases of shoulder dislocation. Patients were followed up after treasure to understand the recovery situation of patients’ shoulder function. Constant-Muley shoulder function score was utilized to assess the therapeutic outcomes.Result 49 patients after surgery and 44 patients treated conservatively were followed up and the time vary from 18 months to 60 months(means, 30.5 months). The follow-up results are following: In Type Ⅰ, among the cases of surgical treatment with fracture displacement more than 5 mm, evaluation excellent for 8 cases, good for 9 cases, mild for3 cases, poor for 3 cases; among the cases of conservative treatment with fracture displacement more than 5 mm, excellent for 0 case, good for 0 case, mild for 2 cases,poor for 2 cases; among the cases of conservative treatment with fracture displacement less than 5 mm, excellent for 5 cases, good for 5 cases, mild for 1 case, poor for 1 case. In Type Ⅱ, among the cases of surgical treatment with fracture displacement more than 5mm, evaluation excellent for 8 cases, good for 11 cases, mild for 5 cases, poor for 2 cases;among the cases of conservative therapy with fracture displacement more than 5 mm,excellent for 0 case, good for 0 case, mild for 2 case, poor for 2 cases; among the cases of conservative treatment with fracture displacement less than 5 mm, excellent for 3 cases,good for 5 cases, mild for 1 case, poor for 1 case. In type Ⅲ, among the cases of conservative treatment with fracture displacement more than 5 mm, evaluation excellent for 0, good for 2 cases, mild for 1 case, poor for 0 case; among the cases of conservative treatment with fracture displacement less than 5 mm, evaluation excellent for 3, good for5 cases, mild for 2 cases, poor for 1 case.Conclusion The morphologic classification of fracture of greater tuberosity of humerus proposed by J. Mutch and his colleagues has more significance for guiding Clinical treatment than AO classification and Neer classification. Firstly, in Type Ⅰand Type Ⅱ,for cases, surgery can achieve good biological effect, while for those cases with fracture displacement distance less than 5 mm, conservative treatment is better than surgery.Secondly, because the fracture is stable in Type Ⅲ, conservative treatment can achieve good results. Thirdly, it has no effect on the prognosis of three type of fracture that whether fracture of greater tuberosity of humeral is with shoulder dislocation or not.