Osteosynthesis with a muscle advancement for a severely retracted greater tuberosity avulsion fracture: a case report

Greater tuberosity fractures with severe retraction are surgically challenging, with no universally accepted surgical procedure. This case report presents a case in which a muscle advancement technique was successfully applied to facilitate the reduction and fixation of a severely retracted greater tuberosity fracture. A 75-year-old female presented with persistent left shoulder pain for more than 3 weeks following a fall. Radiographs revealed a displaced greater tuberosity fracture. During surgery, via a deltoid-split approach, initial attempts to reduce the fragments using sutures placed in the rotator cuff tendons were unsuccessful due to strong traction from the rotator cuff muscles. To overcome this, the supraspinatus and infraspinatus were elevated from the scapular body, allowing the greater tuberosity fragments to slide laterally and achieve anatomical reduction. The fracture was then stabilized using the suture-bridge technique. Postoperative recovery resulted in satisfactory shoulder functional outcomes and complete bone union. To the best of knowledge, this is the first reported case of utilizing a muscle advancement technique in the treatment of a greater tuberosity fracture, providing an effective method to reduce rotator cuff traction and enable stable anatomical fixation. Cite this article as: Furuhata R, Shiba Y, Tanji A, Matsumura N. Osteosynthesis with a muscle advancement for a severely retracted greater tuberosity avulsion fracture: A case report. Acta Orthop Traumatol Turc., Published online October 27, 2025. doi:10.5152/j.aott.2025.25415.