International Orthopaedics

, Volume 43, Issue 5, pp 1215–1222 | Cite as

Size of greater tuberosity fragment: a risk of iatrogenic injury during shoulder dislocation reduction

  • Junfei Guo
  • Yueju Liu
  • Lin Jin
  • Yingchao Yin
  • Zhiyong HouEmail author
  • Yingze Zhang
Original Paper



Shoulder dislocation with greater tuberosity fractures (GTF) is becoming increasingly common, as is the number of cases of iatrogenic humeral neck fractures (IHNF) during reduction. This study investigated the relationship between size of greater tuberosity fragment and occurrence of IHNF in patients with shoulder dislocation and GTF.


A retrospective study was made to identify all patients presenting with shoulder dislocation with GTF between September 2014 and July 2016. There were 74 patients with an average age of 52.4 years (range 18–84 years) representing 76 cases of shoulder dislocation associated with GTF. Patient age, injury mechanism and location, treatment waiting time, and reduction method were noted. Using conventional anterior-posterior view radiographs, three points were identified as A, B, and C. Distance ratios between AC and AB were calculated, then the resulting ratio was compared to a critical value of 0.4.


More iatrogenic fractures occurred in cases where the AC/AB ratio exceeded 0.4. Most (13) occurred during emergency Hippocratic manual reduction. Only five of 18 iatrogenic fractures (27.78%) occurred during surgery while under traction. Women ran a higher risk of iatrogenic fracture than men (female/male ratio 8:1). On average, women were older than men at the time of fracture (59.75 years for women vs. 42 years for men).


A statistically significant relationship exists between size of greater tuberosity fragment and occurrence of iatrogenic humeral neck fractures during the reduction of shoulder dislocation. The larger the greater tuberosity fragment, the higher the incidence of iatrogenic humeral neck fractures. For such fracture dislocations, we recommend open reduction with internal fixation directly and using a Kirschner wire in advance to reinforce the proximal humerus before reduction of the shoulder.


Shoulder dislocation Size of greater tuberosity fragment Reduction Iatrogenic neck fracture Retrospective study 



greater tuberosity fractures


less tuberosity fracture


iatrogenic humeral neck fractures


open reduction with internal fixation


Orthopaedic Trauma Association

ROC curve

receiver operating characteristic curve



Proofreading and revision services were provided by a professional editor.

Author contributions statement

Junfei Guo and Zhiyong Hou designed the study. Junfei Guo and Lin Jin collected the data of the study. Junfei Guo drafted the manuscript. Yingchao Yin, Yueju Liu, Zhiyong Hou, and Yingze Zhang revised the manuscript before submission. All authors read and approved the final manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the institutional internal review board of the participating institution.

Informed consent

For this type of study, formal consent is not required.


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Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  1. 1.Department of Orthopaedic SurgeryThird Hospital of Hebei Medical UniversityShijiazhuangChina

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