Greater Tuberosity Fractures Of Humerus Research Articles

Excellent clinical and radiological outcomes after arthroscopic reduction and double row-suture bridge for large-sized greater tuberosity fractures of the humerus.

Currently, there is limited information on the clinical outcomes of arthroscopic reduction and double-row suture bridge fixation for large greater tuberosity fractures of the proximal humerus. This study aimed to evaluate the radiological and clinical outcomes of arthroscopic reduction and double-row suture bridge fixation for these fractures, hypothesizing that arthroscopic reduction and double-row suture bridge fixation is a safe, effective and minimally invasive treatment for large greater tuberosity fractures. This retrospective study analysed patients with large greater tuberosity fractures (fracture fragment ≥30 mm in diameter) who underwent arthroscopic reduction and double-row suture bridge fixation and had a follow-up period exceeding 2 years. The anatomic reduction was confirmed by assessing the step-off on radiographs immediately after surgery, and the radiologic union time was recorded. At the final follow-up, range of motion and functional outcome scores were evaluated. Additionally, any surgery-related complications were evaluated. Fifteen patients with a mean follow-up of 57.7 ± 23.1 months were included in the study. The mean fracture fragment size was 32.5 ± 2.4 mm, with a mean displacement of 5.1 ± 1.6 mm. Immediately postsurgery, 13 of 15 patients (86.7%) had a fracture step-off of <3 mm, with an average union time of 3 months. At the final follow-up, patients demonstrated excellent outcomes, with an average forward flexion of 167 ± 9.7° and external rotation of 70 ± 16.3. Functional outcome scores showed significant improvement compared with preoperative scores (p < 0.001). No major surgery-related complications were reported. Arthroscopic reduction and double-row suture bridge fixation for large-sized greater tuberosity fractures is safe and shows good fracture reduction and excellent clinical outcomes. Therefore, this surgical method can be considered an alternative to open reduction for large greater tuberosity fractures. Level IV.

Additional cuff suture provides mechanical advantage for fixation of split-type greater tuberosity fracture of humerus

PurposeSplit type of greater tuberosity fracture has variety of surgical treatment options. This study aimed to compare the biomechanics property of additional cuff suture and other fracture fixation techniques. MethodsFifteen porcine humeri were categorized into three groups of fixation techniques those were proximal humeral internal locking system (PHILOS) plate with 2 cuff sutures, nonlocking (conventional, 3.5 mm) T-plate with 2 cuff sutures and T-plate with washer that had additional cuff suture (novel technique). Fracture was created by greater tuberosity osteotomy with 50˚ inclination to the line of surgical neck and then fixed with different prescribed techniques. Displacement of fracture site was measured with universal testing machine. The maximum forces to produce 3 mm, 5 mm of displacement and load to failure were recorded. ResultsThe average loads to reach 3 mm, 5 mm displacement and failure were 30.8 N, 45.4 N and 161 N for nonlocking T-plate; 76.6 N, 99.2 N and 144 N for PHILOS plate; 95.8 N, 120 N and 197 N for novel technique. The differences among three groups were significant in load to displacement at 3 and 5 mm (but not significant in load to failure). For load to reach 3- and 5-mm displacement, PHILOS plate and novel technique were significantly stronger than nonlocking T-plate (P < 0.05). For load to reach 3 and 5 mm displacement, novel technique was stronger than PHILOS plate but not significant (P > 0.05). For load to failure, novel technique was stronger than nonlocking plate and PHILOS plate but not significant (P < 0.05). ConclusionThe important factors affecting the strength of fracture fixation are type of plate and numbers of suture augmentation that tie to the plate. Fixation with additional cuff suture showed the superior biomechanics of load to reach 3 mm, 5 mm displacement with better load to failure compared with PHILOS plate and conventional T-plate alone.

Arthroscopic transtendinous suture bridge (Speed Bridge) for the treatment of greater tuberosity fracture of humerus

To explore clinical effect of shoulder arthroscopic speedbridge technique in treating avulsion fracture of greater tuberosity of humerus. From March 2014 to March 2020, 39 patients with avulsion fracture of greater tuberosity of humerus were treated with speedbridge technique under shoulder arthroscopy. There were 22 males and 17 females aged from 23 to 67 years old with an average of(46.0±11.9) years old. The courses of disease ranged from 3 to 11 days with an average of (3.9±2.4) days. Preoperative and postoperative at 12 months, Constant-Murley shoulder function score and University of California, Los Angeles(UCLA) score were used to evaluate clinical effect. All patients were followed up from 8 to 21 months with an average of (11.5±3.8) months. Fracture healing time ranged from 2 to 4 months with an average of(3.3±0.9) months. No complications such as poor incision healing and joint adhesion occurred. Constant Murley score of shoulder joint was increased from(56.20±1.50) preoperativly to(94.80±2.60) at 12 months after operation(t=-55.42, P<0.01), and 38 patients got excellent result and 1 good. UCLA score was increased from(9.24±1.48) preoperativly to(32.82±1.37) at 12 months after operation(t=-65.67, P<0.01), and 37 patients got excellent result, and 2 good. Arthroscopic suture bridge technique for the treatment of greater tuberosity fracture of humerus could significantly reduce pain and improve function of shoulder.

Self-made dentation hook plate associated with hot-air balloon technique on treatment of Mutch Ⅰ or Ⅱ type isolated greater tuberosity fractures of humerus

To observe effectivness and safeness of self-made dentation hook plate associated with hot-air balloon technique in treating Mutch Ⅰ or Ⅱ type isolated greater tuberosity fractures of humerus. Between January 2016 and December 2018, 15 patients with Mutch Ⅰ or Ⅱ type greater tuberosity fractures were treated with self-made dentation hook plate associated with hot-air balloon technique. There were 9 males and 6 females with an average age of 45.1 years (range, 29-62 years). The injury causes included falling injury in 9 patients and traffic accident injury in 6 patients. According to Mutch classification, 4 cases were MutchⅠ type and 11 cases were Mutch Ⅱ type. There were 7 cases with anterior dislocation of shoulder. The time from injury to operation was 2-10 days (mean, 4.5 days). All 15 patients were followed up 8-16 months, with an average of 13.5 months. There was no infection of incision, loss of reduction of fracture block, delayed union or nonunion. The average time of fracture union was 6.5 months (range, 4-8 months). One patient had axillary paralysis at 1 day after operation, and was treated with nutritional nerve therapy, the symptoms disappeared after 2.5 months. Three patients had slight subacromial impingement. After fracture healing, the hook plate was taken out in advance, and the pain and abnormal noise disappeared during shoulder abduction. At last follow-up, Costant-Murley score used to evaluate shoulder joint function was 88-100, with an average of 96.8; 8 cases were excellent, 7 cases were good, and the excellent and good rate was 100%. The internal fixator was removed after 8-16 months after the secondary operation with no re-fracture occurred. The self-made dentation hook plate associated with hot-air balloon technique is a safe and reliable method for the treatment of Mutch Ⅰ or Ⅱ type isolated greater tuberosity fracture of humerus.

Analysis of Risk Factors for Occult Surgical Neck Fracture Accompanying Isolated Greater Tuberosity Fracture of Humerus

Purpose: An occult surgical neck fracture can be accompanied in isolated greater tuberosity fracture of humerus. The risk factors of occult surgical neck fracture in isolated greater tuberosity fracture were statistically analyzed. Methods: From 2008 to 2017, 74 patients with isolated greater tuberosity fracture of humerus were selected. The occult surgical neck fracture was evaluated by computed tomography or magnetic resonance imaging. Patients were divided into two groups, those with isolated greater tuberosity fractures (group I) and isolated greater tuberosity fractures with occult surgical neck fracture (group II). For the risk factor analysis, the age, sex, underlying disease, injury mechanism, and body mass index between the two groups were compared. Radiologically, fracture pattern, the amount of displacement, and the presence and direction of the shoulder joint dislocation were compared.Results: In multivariate analysis, factors independently related to the occurrence of occult surgical neck fractures were gender and whether or not the joint dislocation. In women (odds ratio [OR]=14.806; 95% confidence interval [CI], 1.188–184.503; p=0.036) and in cases where no joint dislocation occult surgical neck fracture (OR=0.018; 95% CI, 0.001–0.271; p=0.004) was accompanied more frequently and occurred statistically.Conclusion: Care must be taken in cases of female and the absence of shoulder dislocation in isolated greater tuberosity fracture because of the possibility of occult surgical neck fracture.

Displaced isolated greater tuberosity fractures of elder adults treated with plate osteosynthesis.

We elucidated the effect of open reduction and internal fixation with locking plate for acute isolated displaced greater tuberosity fractures of humerus in elder adults (aged >60 years). From 2009 to 2015, data from 32 patients, aged between 60 and 88 years, who had acute unilaterally displaced greater tuberosity fractures of humerus were collected and evaluated retrospectively. All the fractures were managed with open reduction and internal fixation with locking plate. The follow-up period was 50.8 months on an average (range 22-80 months). Finally, 25 patients were available for final evaluation of radiographic and functional results. All the 32 fractures had union with the average union time of 14 weeks (range 10-18 weeks) and with no complications. The average of preoperative Visual Analogue Scale (VAS) was 6.2 (range 4-8), ASES was 30.4 (range 13-45), and Constant score was 30.4 (range 20-45). At the last follow-up, the mean VAS was 1.3 (range 0-2.5), the mean ASES score was 90.1 (range 72-100), and the mean Constant score was 90.3 (range 80-100). There were statistically significant differences between preoperative and final follow-up in VAS, ASES, and Constant score. Hundred percent of patients had good or excellent results by Constant score, with excellent results (86-100) in 17 (68%) patients and good result (71-85) in 8 (32%). In conclusion, open reduction and internal fixation with locking plate is an effective treatment for acute displaced greater tuberosity fractures of humerus in elder adults.

Clinical outcomes of minimally invasive open reduction and internal fixation by screw and washer for displaced greater tuberosity fracture of the humerus

The purpose of this study was to investigate clinical and radiologic outcomes of open reduction and internal fixation with a screw and washer for a displaced greater tuberosity fracture of the proximal humerus through a small incision. We retrospectively reviewed 29 patients who underwent open reduction and internal fixation with a screw and washer for a greater tuberosity fracture of the proximal humerus. After surgery, the patients were immobilized in a brace for 4 weeks. To determine clinical outcomes, we evaluated a visual analog scale pain score; the Subjective Shoulder Value; the University of California, Los Angeles shoulder score; the American Shoulder and Elbow Surgeons score; and active range of motion. All patients achieved bone union within 3 months after surgery. At the 2-year follow-up, the mean visual analog scale pain score was 1.1 ± 1.1; Subjective Shoulder Value, 93.4 ± 5.3; University of California, Los Angeles shoulder score, 31.2 ± 2.7; and American Shoulder and Elbow Surgeons score, 92.6 ± 6.7. Mean active forward flexion, external rotation, and internal rotation were 144° ± 16°, 33° ± 11°, and 13.3 ± 1.7, respectively. Postoperatively, 9 patients (31%) had stiffness and pain refractory to conservative treatment and underwent arthroscopic release. Although minimal open reduction and screw and washer fixation resulted in bone union in all cases, the incidence of postoperative stiffness was relatively high in patients with displaced greater tuberosity fractures because of prolonged immobilization after surgery.

Arthroscopic percutaneous inverted mattress suture fixation of isolated greater tuberosity fracture of humerus

The purpose of the study was to evaluate the clinical and radiographic outcomes of treatment in patients with isolated greater tuberosity (GT) fractures of humerus using arthroscopic percutaneous inverted mattress suture fixation technique. We attempted to use the arthroscopic percutaneous inverted mattress suture fixation technique in 17 consecutive cases with isolated displaced GT fractures. Fourteen patients were successfully treated without switching to other methods and were available for follow-up at a mean of 22 months (range: 17-38 months) after surgery. For assessment of clinical outcomes, we evaluated the range of motion and the visual analog scale (VAS) score, the shoulder index of the American Shoulder and Elbow Surgeons (ASES), and the Korean Shoulder Scale (KSS). At the final follow-up, the VAS improved to 1.0 points (range: 0-3), the mean ASES score improved to 86.9 points (range: 78.3-100) and the KSS improved to 88.6 points (range: 82-100) postoperatively. Mean union time was 10 weeks. Mean forward flexion was 167.8° (range: 140-180°), mean external rotation in neutral position was 36° (range: 20-70°), and mean internal rotation was at the 12th thoracic level (range: T6-L3) at final follow-up. Three cases were switched to open surgery after attempted arthroscopic technique due to large fragment or osteoporosis. In select cases, the arthroscopic percutaneous inverted mattress suture fixation of GT fracture is a simple and reproducible technique with encouraging early results.

Percutaneous screw fixation of isolated fractures of the greater tuberosity of the humerus

Background: The unacceptable treatment outcome of the isolated greater tuberosity fracture of the humerus mainly due to missed diagnosis, ignorance, or when be trivialized. Patients and Methods: Twelve patients with isolated, displaced fracture of the greater tuberosity of the humerus were treated with closed reduction and percutaneous fixation using one or two screws. The indication for surgery was 3 - 5 mm of displacement in any plane in a mean fragment without comminution. The cause of injury was sports in three patients, motor car accidents in five patients, and hyper abduction-external rotation of the shoulder during a fall in four patients. Results: Radiographic union of the tuberosity was seen in all fractures. There was no heterotopic bone formation in any patient. Functional results were excellent in 8 patients (Constant score: 90.5%), good in 2 patients (Constant score: 81.5%) and satisfactory in 2 patients (Constant score: 70 %). All patients were satisfied with the outcome and the overall mean Constant score was 85.5%. Conclusion: Closed reduction and percutaneous fixation of large displaced fragment greater tuberosity fracture of the proximal humerus is a good technique providing stable fixation and less or no soft tissue complications as infection, muscle weakness, and adhesions. The technique should be done by experienced surgeon with intra-operative fluoroscopy. The screw is better used with washer for not to damage the fragment during compression.

A case experienced to be greater tuberosity fracture of humerus to bilateral shoulder

A case experienced to be greater tuberosity fracture of humerus to bilateral shoulder

Examination of arthroscopic surgery for greater tuberosity fractures of humerus

Examination of arthroscopic surgery for greater tuberosity fractures of humerus

The Spectrum of Lesions and Clinical Results of Arthroscopic Stabilization of Acute Anterior Shoulder Instability

PurposeThe purpose of this study is to investigate and analyze accom-panying lesions including injury types of anteroinferior labrum lesion in young and active patients who suffered traumatic anterior shoulder dislocation for the first time.Meterials and MethodsThe study used magnetic resonance angiography (MRA) to 40 patients with acute anterior shoulder dislocation from April 2004 to April 2008, and of those, 36 with abnormal MRA finding were treated with arthroscopy.ResultsThere was a total of 25 cases of anteroinferior glenoid labrum lesions. A superior labrum anterior-posterior lesion (SLAP) lesion was observed in 8 cases. For bony lesions, 22 cases of Hill-sachs lesions, 4 cases of lesions in greater tuberosity fracture of humerus, and 4 cases of loose body were found. For lesions involving rotator cuff, partial articular side rupture was found in 2 cases and 2 cases were found to have a complete rupture.ConclusionUnder MRA and arthroscopy performed on patients with acute anterior shoulder dislocation, it was observed to have varying types of anteroinferior labrum lesions such as Perthes, Bankart, ALPSA, and bony Bankart lesion. that MRA is a remar-kably useful tool to classify various lesions in acute anterior dislocation of the shoulder and to make a diagnosis, making it a useful tool to decide a treatment method while consulting patients and their families.

Characteristics of an isolated greater tuberosity fracture of the humerus

BackgroundMost classification systems tend to include isolated greater tuberosity fractures in the group of proximal humeral fractures. The purpose of this study was to elucidate demographic differences between isolated greater tuberosity fractures and the other proximal humeral fractures. MethodsAltogether, 610 proximal humeral fractures were divided into isolated greater tuberosity fractures of the proximal humerus (group I) and all other proximal humeral fractures (group II). The two groups were analyzed according to their incidence, age and sex distribution, presence of dislocation, and associated chronic medical problems. ResultsGroup I comprised 18.9% and group II 8l.l% off all fractures. The mean age of group I was 42.8 years, and that of group II was 54.2 years. Of the 115 (67.8%) patients in group I, 78 (67.8%) were male. In contrast, most of the group II patients were female (332/495, 67.1%). A higher incidence of glenohumeral dislocation occurred in group I (6.9%) than in group II (3.4%). Of the 495 group II patients, 175 (35.4%) had medical problems, including endocrine, cardiovascular, pulmonary, hepatic, and renal disease, whereas only 15 of the 115 (13%) patients in group I had such problems. ConclusionsPatients with isolated greater tuberosity fractures of the proximal humerus were different demographically, and their treatment and classification should be considered separately from that for other proximal humeral fractures.