Transosseous braided-tape and double-row fixations are better than tension band for avulsion-type greater tuberosity fractures

Abstract

IntroductionThe optimal treatment for avulsion-type greater tuberosity fractures is yet to be determined. Three fixation methods are tested: tension band with #2 wire suture (TB), double-row suture bridge with anchors (DR), and simple transosseous fixation with braided tape (BT). Materials and methodsTwenty-four porcine proximal humeri were randomised into three groups: TB, DR and BT. A standardised greater tuberosity (GT) osteotomy was performed at 90° to the humeral diaphysis axis. A mechanical testing machine was used to simulate supraspinatus contraction. The force required to produce 3mm and 5mm displacement, as well as complete failure was measured with an axial load cell. Also, three cycles of shoulder flexion/extension with 25N of supraspinatus contraction were performed. Maximum GT fragment translation and rotation amplitude during one cycle were measured. ResultsDuring supraspinatus contraction, DR and BT groups (p<0.05) were superior to TB group for both displacements. The BT technique had the strongest maximal load to failure (BT=466N; DR=386N; TB=320N). For the flexion/extension, DR and BT groups had less displacement and rotation than TB group (anterio-posterior displacement: BT=2.0mm, DR=1.9mm, TB=5.8mm; anterio-posterior angular displacement: BT=1.4°, DR=1.0°, TB=4.8°). No significant difference was observed between DR and BT groups, except for the medio-lateral rotation favouring the DR group. ConclusionIn conclusion, BT and DR are good fixation methods to treat displaced avulsion-type greater tuberosity fractures. They have similar mechanical properties, and are stronger and more stable that the TB construct. Potential advantages of the BT over the DR may be a lower cost and easier surgery. Level of evidenceBasic science study (LEVEL II).