Arthroscopic fixation of humeral greater tuberosity fracture using a W-shaped suture

Xiaocong Lin,Zhangsheng Dai,Xiuxi Huang,Kaibin Fang

doi:10.1186/s13018-020-02077-8

Abstract

BackgroundPatients with greater tuberosity fractures of the humerus often require surgery. Therefore, there is a need to find a minimally invasive and effective surgical procedure with great patient outcomes.AimTo evaluate the clinical outcomes of the W-shaped suture technique under shoulder arthroscopy in the treatment of greater tuberosity fractures of the humerus.MethodsIn this retrospective study, a total of 17 patients were included. The fractures were closed, and there was no neurovascular injury. These patients underwent arthroscopically assisted reduction and internal fixation of the greater tuberosity fractures. Fixation was performed using sighting nails combined with a W-shaped suture. The imaging data of the patients were collected, and the ASES score, Constant-Murley score, and VAS score were used to evaluate the patient’s outcome. At the last follow-up (at least 1 year), the range of motion in the affected shoulder was compared with that of the contralateral side.ResultsThe operation was successful in all the patients. The average follow-up time was 13 months. There were no reported complications such as fracture displacement, nonunion, and internal fixation failure during the follow-up period. Post-operative X-ray examinations revealed good function recovery, with a healing time of between 10 and 12 weeks, and an average healing time of 11.5 weeks. Following the operation, patients reported reduced shoulder joint pain that no longer influenced their activity or caused discomfort in their daily life. The patient’s VAS score ranged from 0 to 3, with an average of 0.52 ± 0.73, while at the last follow-up, the Constant-Murley score ranged from 83 to 97, with an average of 92.33 ± 7.55. The ASES score ranged from 81 to 98, with an average of 93.15 ± 6.93. At the last follow-up, there was no significant difference in the overall range of motion with the unaffected limb.ConclusionThis study demonstrates that the W-shaped suture can be used to effectively fix the fractures of the greater tuberosity of the humerus, by increasing the fixed area to promote healing.

Highlights

Patients with greater tuberosity fractures of the humerus often require surgery
We retrospectively evaluated the clinical outcome of the fixation of humeral greater tuberosity fracture using the W-shaped suture technology
Postoperative X-ray film showed that the fracture was well reduced, and there was no internal fixation failure and none of the anchors had pulled out

Summary

Introduction

Patients with greater tuberosity fractures of the humerus often require surgery. The greater tuberosity fracture of the humerus is one of the common proximal humerus fractures among the young and male population [1]. The arm of the rotator cuff tendon is destroyed following a fracture of the greater tuberosity of the humerus. When the fracture appears displaced, reduction and internal fixation of the greater tuberosity fractures are necessary. Open reduction and the cannulated screw fixation technique have been widely used to treat a displaced greater tuberosity fracture [3, 4]. Cannulated screw fixation of the greater tuberosity fracture is associated with increased morbidity due to comminution or migration of the fractured fragment and poor fixation

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