Rationale for Patient Selection
- 41-year-old, right-hand-dominant male laborer with a right comminuted displaced 3-part fracture sustained from a 10-foot fall from a ladder
- Patient’s younger age and employment as a laborer make preservation of the greater tuberosity and attached rotator cuff muscles critical to maintain strength in overhead activities
- Workers’ compensation injury
- 1 ppd smoker
Assessment of Injury
- Non-displaced vertical fracture in the greater tuberosity. Varus malalignment of fracture
External Fixator Placement
- Total operative time for placement: 43 minutes
- Week 1: Images show that the lateral greater tuberosity is still not displaced, and the posterior pins have helped stabilize it so that it doesn’t displace
Post-op Progress
Week 9: Patient did not return for exam according to schedule and was not following instructions regarding limiting his arm use. Images show some displacement of the fracture, but it is still in an acceptable position. The patient was advised to limit arm use
Six months: Patient is seen for the last time at 6 months post-pin removal. He reports no pain and has good range of motion with forward flexion at 140°. Images show that the fractures are more solidly healed
Outcomes Achieved
- Good healing and alignment
- No signs of infection
- The patient reports no pain
- Range of motion is good with forward flexion of 140°
- Preserved rotator cuff function
- Returned to work