Journal of the Pediatric Orthopaedic Society of North America · 2025
Pediatric Humeral Tuberosity Fractures: Presentation, Management, and Early Outcomes.
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Isaacs David, Syed Akbar N, Yaya-Quezada Carlos, Nguyen Jie C, Lawrence John T R
Аннотация
BACKGROUND: Humeral tuberosity fractures are rare injuries in the pediatric population. Prior literature consists of small case series reporting on lesser tuberosity (LT) involvement, with limited reports on greater tuberosity (GT) fractures. The aim of this study is to describe presentation, management, and early outcomes of greater and lesser tuberosity fractures in the pediatric population.
METHODS: A retrospective review was performed following Institutional Review Board approval for pediatric patients presenting with humeral tuberosity fractures between January 1, 2008, and August 30, 2024. Patients with inadequate documentation, unconfirmed tuberosity involvement, or underlying neuromuscular conditions were excluded. Demographic, injury, and treatment characteristics were collected. Descriptive statistical analysis was performed.
RESULTS: Nineteen patients were included in the final cohort, with 10 GT fractures and 9 LT fractures. Mean age at time of injury was 14.6 years with 100% male patients. Sports-related activity was the most common mechanism overall (52.7%) and for LT fractures (77.8%), while traumatic mechanism was most common in GT fractures (70.0%). Sixteen patients had available imaging at time of injury. Eleven of these patients (68.8%) had a displaced fracture (>2 mm) with average displacement of 4.6 mm. Seven fractures (36.8%) were radiographically occult, and advanced imaging was utilized in 17 patients (89.5%). GT fractures were treated operatively in 30.0% of cases and nonoperatively in 70.0%. LT fractures were treated operatively in 11.1% of cases. Seven patients had complications (36.8%), all of which occurred in patients treated with nonoperative management initially. Complications were higher in LT fractures (55.6%) compared to GT (20.0%) and when there was a delay in diagnosis (100%, n = 2).
CONCLUSIONS: Greater and lesser tuberosity fractures occur at similar rates. Sports was the predominant mechanism for LT fractures while GT fractures more frequently occurred during non-sports-related traumatic injuries. Advanced imaging was commonly used to confirm the diagnosis, suggesting that there should be a low threshold for obtaining advanced imaging. Complication rates were higher with LT involvement, delay in diagnosis, and nonoperative management.
KEY CONCEPTS: (1)Greater tuberosity and lesser tuberosity fractures tend to have different mechanisms of injury, with greater tuberosity injuries occurring more often secondary to non-sports trauma and lesser tuberosity fractures occurring secondary to sports-related activity.(2)Tuberosity fractures may be radiographically occult or present with associated injuries and advanced imaging may be helpful; however, their impact on outcomes needs further investigation.(3)Complications were highest when the fracture occurred in the lesser tuberosity, when there was a delay in diagnosis, or when nonoperative management was initially performed, thus careful selection of surgical candidates and early diagnosis are paramount.
LEVEL OF EVIDENCE: Level IV.
METHODS: A retrospective review was performed following Institutional Review Board approval for pediatric patients presenting with humeral tuberosity fractures between January 1, 2008, and August 30, 2024. Patients with inadequate documentation, unconfirmed tuberosity involvement, or underlying neuromuscular conditions were excluded. Demographic, injury, and treatment characteristics were collected. Descriptive statistical analysis was performed.
RESULTS: Nineteen patients were included in the final cohort, with 10 GT fractures and 9 LT fractures. Mean age at time of injury was 14.6 years with 100% male patients. Sports-related activity was the most common mechanism overall (52.7%) and for LT fractures (77.8%), while traumatic mechanism was most common in GT fractures (70.0%). Sixteen patients had available imaging at time of injury. Eleven of these patients (68.8%) had a displaced fracture (>2 mm) with average displacement of 4.6 mm. Seven fractures (36.8%) were radiographically occult, and advanced imaging was utilized in 17 patients (89.5%). GT fractures were treated operatively in 30.0% of cases and nonoperatively in 70.0%. LT fractures were treated operatively in 11.1% of cases. Seven patients had complications (36.8%), all of which occurred in patients treated with nonoperative management initially. Complications were higher in LT fractures (55.6%) compared to GT (20.0%) and when there was a delay in diagnosis (100%, n = 2).
CONCLUSIONS: Greater and lesser tuberosity fractures occur at similar rates. Sports was the predominant mechanism for LT fractures while GT fractures more frequently occurred during non-sports-related traumatic injuries. Advanced imaging was commonly used to confirm the diagnosis, suggesting that there should be a low threshold for obtaining advanced imaging. Complication rates were higher with LT involvement, delay in diagnosis, and nonoperative management.
KEY CONCEPTS: (1)Greater tuberosity and lesser tuberosity fractures tend to have different mechanisms of injury, with greater tuberosity injuries occurring more often secondary to non-sports trauma and lesser tuberosity fractures occurring secondary to sports-related activity.(2)Tuberosity fractures may be radiographically occult or present with associated injuries and advanced imaging may be helpful; however, their impact on outcomes needs further investigation.(3)Complications were highest when the fracture occurred in the lesser tuberosity, when there was a delay in diagnosis, or when nonoperative management was initially performed, thus careful selection of surgical candidates and early diagnosis are paramount.
LEVEL OF EVIDENCE: Level IV.