Causes / typical injury mechanism: Greater tuberosity (GT) fracture of the humerus is often caused by a fall on the outstretched hand (FOOSH) with the elbow in full extension or flexion. Shoulder dislocations often result in fractures of the GT of the humerus. The fracture can also be caused by an extreme pull of the external rotators of the arm after abduction and external rotation, a direct trauma to the lateral aspect of the shoulder, or a seizure.

Classic history and presentation: A classic history is an older patient with osteoporosis who fell from standing height onto an outstretched hand.

Prevalence:

• Age – Usually seen in patients older than 50 years.
• Sex / gender – Twice as common in female patients.

Risk factors: Osteoporosis, old age, athletic participation, motor vehicle crashes.

Pathophysiology: GT fractures are caused by traumatic injury to the arm or shoulder joint. The fragment generally gets pulled superiorly by the supraspinatus and/or infraspinatus.

Grade / classification system: Neer classification for proximal humerus fractures.

In order to be classified as a fractured part, the fractured component needs to either be displaced greater than 1 cm or have angulation exceeding 45 degrees. The exception is the greater tuberosity, which is considered displaced at 5 mm.

• One-Part Fracture
  • Fracture involves 1-4 parts.
  • No parts are displaced.
• Two-Part Fracture
  • Fracture involves 2-4 parts.
  • One part is displaced.
• Three-Part Fracture
  • Fracture involves 3-4 parts.
  • Two parts are displaced.
• Four-Part Fracture
  • Fracture involves more than 4 parts.
  • Three parts are displaced.