Minimally invasive open reduction of greater tuberosity fractures by a modified suture bridge procedure

BACKGROUND Most greater tuberosity fractures can be treated without surgery but some have a poor prognosis.The surgical procedures for avulsion fractures of the humeral greater tuberosity include screw fixation,suture anchor fixation,and plate fixation,all of which have treatment-associated complications.To decrease surgical complications,we used a modified suture bridge procedure under direct vision and a minimally invasive small incision to fix fractures of the greater tuberosity of the humerus.AIM To investigate the clinical efficacy and outcomes of minimally invasive modified suture bridge open reduction of greater tuberosity evulsion fractures.METHODS Sixteen patients diagnosed between January 2016 and January 2019 with an avulsion-type greater tuberosity fracture of the proximal humerus and treated by minimally invasive open reduction and modified suture bridges with anchors were studied retrospectively.All were followed up by clinical examination and radiographs at 3 and 6 wk,3,6 and 12 mo after surgery,and thereafter every 6 mo.Outcomes were assessed preoperatively and postoperatively by a visual analog scale(VAS),the University of California Los Angeles(UCLA)shoulder score,the American Shoulder and Elbow Surgeon score(ASES),and range of motion(ROM)for shoulders.RESULTS Seven men and nine women,with an average age of 44.94 years,were evaluated.The time between injury and surgery was 1-2 d,with an average of 1.75 d.The mean operation time was 103.1±7.23 min.All patients achieved bone union within 3 mo after surgery.VAS scores were significantly decreased(P=0.002),and the mean degrees of forward elevation(P=0.047),mean degrees of abduction(P=0.035),ASES score(P=0.092)were increased at 3 wk.The UCLA score was increased at 6 wk(P=0.029)after surgery.The average degrees of external rotation and internal rotation both improved at 3 mo after surgery(P=0.012 and P=0.007,respectively).No procedure-related deaths or incision-related superficial or deep tissue infections occurred.CONCLUSION Modified suture bridge was effective for the treatment of greater tuberosity evulsion fractures,was easier to perform,and had fewer implants than other procedures.

Arthroscopic reduction and fixation for isolated greater tuberosity fractures

Background Traditionally, displaced greater tuberosity fractures are treated with open reduction and internal fixation. Arthroscopic treatment and outcome of greater tuberosity fractures is far from comprehensive. The objective of the current study was to assess the surgical procedure and outcome of an arthroscopic method in the treatment of isolated greater tuberosity fractures. Methods From January 2006 to December 2009, 23 patients with isolated greater tuberosity fractures were treated with an arthroscopic procedure using three cannulated screws combined with washers. During follow-up, radiographs and the constant shoulder score （CSS） were used to evaluate the outcome. Results Three cannulated screws with washers were used to fix the fractured fragment of the greater tuberosity under an arthroscope. All incisions healed at primary intention without infection. The mean duration of follow-up was 20 months （range 18-36 months）. Fracture fixation was excellent, and fractures healed 2-6 months （mean 3.8 months） after surgery. At final follow-up, the CSS was 92 （range 86-100）. Conclusions The described arthroscopic procedure provides anatomical reduction and firm fixation for isolated greater tuberosity fractures. It is a successful and minimally invasive procedure with satisfying therapeutic effects as well as excellent functional recovery.