Delayed refixation of a lesser tuberosity avulsion fracture in a young male with open growth plate: successful repair four years after missed injury.

BACKGROUND: Isolated avulsion fractures of the humeral lesser tuberosity in adolescents with open growth plates are rare and frequently overlooked due to subtle clinical and radiographic findings. Delayed diagnosis may result in persistent internal rotation weakness and functional impairment. This report aims to highlight the diagnostic challenges and clinical course of a markedly delayed presentation of this uncommon injury.

CASE PRESENTATION: A 19-year-old male presented with persistent weakness in shoulder internal rotation. He reported a traumatic shoulder injury at the age of 15 that had not been further evaluated. Clinical examination and imaging confirmed a chronic avulsion fracture of the humeral lesser tuberosity. Surgical treatment was performed using suture anchors in a double-row fixation technique. Postoperative rehabilitation followed a standardized protocol, and functional recovery was assessed clinically over a six-month follow-up period. By six months postoperatively, the patient had regained full range of motion and restored internal rotation strength. He returned to unrestricted daily activities without pain or functional limitation. No complications were observed during follow-up.

CONCLUSIONS: Avulsion fractures of the humeral lesser tuberosity in skeletally immature patients can remain undiagnosed for years due to subtle presentation. Persistent internal rotation weakness after trauma in adolescents should raise suspicion for this injury. Even in cases of markedly delayed diagnosis, appropriate surgical management can result in excellent functional recovery.