title: Isolated fractures of the greater tuberosity of the humerus: solutions to recognizing a frequently overlooked fracture.
abstract: BACKGROUND
  Although isolated fracture of the greater tuberosity of the humerus had been regarded as an easily overlooked fracture, recent literature focusing on its diagnosis is scarce. The purpose of this study was to elucidate the rate of missed diagnosis of isolated humeral greater tuberosity fracture and pitfalls in diagnosis and to ascertain the most effective method for preventing missed diagnosis.
  
  
  METHODS
  One hundred sixty-three shoulders, of which diagnosis was made by radiography for all and by proving a localized tenderness on the lateral wall of the greater tuberosity for the acute cases, were retrospectively reviewed. The diagnoses made at the previously visited clinic were analyzed, as was the relationship between missed diagnosis and other pertinent factors such as the extent of fracture and the amount of displacement of the fractured fragment.
  
  
  RESULTS
  Fractures were overlooked in 58 of the 99 shoulders (59%) that had been initially examined at other clinics. The rate (64%) of missed diagnosis in one-part fractures was significantly higher than that (27%) in two-part fractures (p < 0.01). Twenty-five (76%) of 33 isolated supraspinatus (SSP) (facet for the SSP), 26 (57%) of 46 SSP + infraspinatus (ISP) (facet for the infraspinatus ISP), and 6 (33%) of 18 SSP + ISP + teres minor (facet for the teres minor) fractures were overlooked at previous clinics. The smaller the fragment, the higher the rate of missed diagnosis (p < 0.05).
  
  
  CONCLUSIONS
  Isolated fracture of the greater tuberosity remains an easily overlooked injury. The likelihood of this missed diagnosis increases with the fracture being limited to the SSP facet and decreases as the fracture extends posteriorly. Confirming the presence of tenderness on the lateral wall of the greater tuberosity is a clinically effective method for preventing missed diagnosis.
authors.affiliation: Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan.
authors.forename: Kiyohisa
authors.initials: K
authors.lastname: Ogawa
authors.forename: Atsushi
authors.initials: A
authors.lastname: Yoshida
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Ikegami
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D006810:Humeral Fractures / Q000000981:diagnostic imaging* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D012307:Risk Factors; D018709:Statistics, Nonparametric