Isolated Greater Tuberosity Fractures Research Articles

Outcomes of open reduction and internal fixation using 2.0/2.4 mm locking compression plate in isolated greater tuberosity fractures of humerus

Background: The purpose of this study was to retrospectively evaluate the radiographic and clinical results of a small single or double low-profile plate fixation of 2.0/2.4 mm locking compression plate (LCP) in treating isolated greater tuberosity (GT) fractures of the humerus. Methods: From June 2015 to October 2022, patients who underwent LCP in treating isolated GT fractures of the humerus were included in this study. The radiological and clinical results were analyzed in 15 patients who underwent open reduction and internal fixation used 2.0/2.4 mm LCP. Results: Bone union was achieved in 14 patients (93.3%) and one failed case was treated with a 2.4 mm single LCP fixation. Radiological union was achieved within 10–20 weeks. Complications occurred in two patients (13.3%), including the reduction failure and shoulder stiffness. At the final follow-up, the average clinical scores were as follows: a visual analog scale for pain of 2.1 (range, 0–5) and a University of California, Los Angeles score of 27.2 (range, 18–31). Regarding range of motion (ROM), the average active ROMs were 142° for forward flexion (range, 120°–150°), 147.1° for abduction (range, 120°– 180°), and 59.3° for external rotation (range, 45°–80°). For internal rotation, the average was observed to reach the 10th thoracic vertebra (range, 1st lumbar vertebra–7th thoracic vertebra). Conclusions: The clinical and radiologic outcomes of treating isolated GT fracture using 2.0/2.4 mm LCP were favorable, and double low-profile plate fixation may be beneficial for sufficient fracture stability if possible. Level of evidence: Level IV, case series.

Classification and measurement of displacement of isolated greater tuberosity fractures: Intra and interobserver reliability.

Literature demonstrates variability in the amount of displacement of isolated greater tuberosity (GT) fractures and measurement techniques that orthopaedic surgeons deem warrant surgical intervention. This study aims to assess the intra and interobserver reliability for classifying and measuring the displacement amount for isolated GT fractures. Eight surgeons, consisting of four shoulder specialists and four trainee surgeons, reviewed 25 plain radiographs on two separate occasions, 3 months apart. They were required to morphologically classify the GT fracture, measure the displacement distance on anteroposterior and axillary views, calculate the GT displacement ratio, and state whether they would offer surgical treatment. There was a lack of good reliability for the classification of the depression and avulsion fracture types. There was good intraobserver but poor interobserver consistency in classifying the split-type fractures. The measurement of the displacement distance showed good intraobserver reliability, but not as good interobserver agreement. Also, the displacement ratio calculated revealed poor consistency. We found good agreement between and within the raters for the treatment decision. No significant difference was noted when comparing the senior surgeons to the junior surgeons. This study has revealed ongoing inconsistency in the classification and measurement of isolated GT fractures.

The role of scapular morphology in traumatic rotator cuff tears and greater tuberosity fractures: A retrospective study

BackgroundTraumatic postero-superior Rotator Cuff Tears (RCT) and isolated Greater Tuberosity fractures (GTF) are equivalent injuries resulting in significant shoulder dysfunction if left retracted or displaced. The difference in morphometric aetiology is unclear. A raised critical shoulder angle (CSA) has been associated with rotator cuff degeneration. We hypothesised that traumatic RCT is associated with a raised CSA when compared to GTF. MethodsA retrospective study was conducted across the two trauma units in our institution. All patients between the period of 2010 and 2020 with Traumatic GTF or RCT assessed on cross-sectional imaging (CT or MRI) were identified. Patients were case-matched by age, gender, mechanism and laterality of injury. The primary outcome measurement was the Critical Shoulder Angle (CSA). Other radiographic features of subacromial degenerative change, mechanism of injury, association with shoulder dislocation and delay to diagnosis were also compared. ResultsEighty patients met the inclusion criteria(40 traumatic RCT and 40 GTF). The mean age was 61.8 years with 58(72.5%) left-sided injuries. Thirty-four (43%) were female.The mean CSA was 3.96° higher in the RCT group (95% CI 2.5 to 5.41, p < 0.05). A CSA of 33.73 gave a sensitivity of 0.68 and a specificity of 0.8 to differentiate between RCT and GTF. Patients with RCT were far more likely to display subacromial degenerate changes and experience a significant delay in diagnosis, whereas those with GTF were more likely to have suffered a shoulder dislocation. ConclusionsPatients with traumatic RCT have radiographic features and scapular morphology associated with degenerative rotator cuff disease compared to those with GTF. This supports the theory that tears occur on the background of pre-existing tendon degeneration. Careful assessment of these parameters, combined with clinical assessment, may help guide the provision of appropriate diagnostic imaging. Level of evidenceIII.

Open Fixation of Displaced Greater Tuberosity Fractures Yields Similar Patient-Reported Outcomes to Acute Arthroscopic Rotator Cuff Repair at 2 Years: A Matched Cohort Analysis

PurposeTo evaluate and compare patient-reported outcomes (PROs) after isolated greater tuberosity (GT) fracture fixation versus acute rotator cuff repair (RCR) at a minimum of 2 years.MethodsPatients who underwent isolated GT fracture fixation were compared in a 1-to-3 fashion with patients who underwent arthroscopic RCR for an acute rotator cuff tear by a single surgeon from January 2006 and to July 2018. Data were prospectively collected and retrospectively reviewed. PROs were compared pre- and postoperatively as well as between groups (American Shoulder and Elbow Surgeons [ASES], General Health Short Form-12 Physical Component [SF-12 PCS], Single Assessment Numerical Evaluation [SANE], Quick Disabilities of the Arm, Shoulder, and Hand [QuickDASH], and satisfaction). Reoperation rates were analyzed.ResultsA total of 57 patients (14 with isolated GT fracture fixation, mean age 45.7 years; and 43 who underwent ARCR for acute tears, mean age 56.6 years) were evaluated (P = .050). ASES scores significantly improved from 39.7 to 94.1 (P = .018) in the isolated GT fracture fixation group and from 51.0 to 95.2 (P < .001) in acute RCR group. At final follow-up, mean QuickDASH scores were 8.9 and 7.9 (P = .677) and SANE scores were 91.1 and 87.3 (P = .616) for the GT and acute RCR groups, respectively. The median satisfaction was 10/10 for the GT group and 10/10 for the RCR group. Additional comparison of patients who underwent double-row repair for an acute rotator cuff tear or isolated GT fracture revealed no significant difference in outcomes (P > .404).ConclusionMinimum 2-year PROs after fixation of isolated GT fractures show relatively high outcome scores whether treated by open reduction and internal fixation or arthroscopic fixation using a double-row bridging technique. The improvements in PROs are similar to those achieved with acute rotator cuff tears that were fixed arthroscopically with RCR. Further analysis of these results suggest that the functional outcomes of tendon-to-bone healing with linked, double-row rotator cuff repairs are similar to those of bone-to-bone healing as seen with GT fractures.Level of EvidenceIII, retrospective comparative study.

The Natural History and Epidemiology of Minimally Displaced and Isolated Greater Tuberosity Fractures

The Natural History and Epidemiology of Minimally Displaced and Isolated Greater Tuberosity Fractures

Open Reduction and Stable Internal Fixation Using a 3.5-mm Locking Hook Plate for Isolated Fractures of the Greater Tuberosity of the Humerus: A 2-Year Follow-up Study Using an Innovative Fixation Method.

BackgroudThe best treatment for isolated greater tuberosity (GT) fractures is still controversial. Although previous studies have suggested surgical options, they are either unable to provide firm fixation or present with a variety of complications.MethodsWe retrospectively studied the records of patients with isolated GT fractures who underwent open reduction and internal fixation using a 3.5-mm locking hook plate between January 2016 and January 2018. The surgical indication was an at least 5-mm displacement of the GT as observed in either simple radiography or three-dimensional computed tomography. Clinical outcomes were assessed using the following five parameters shortly before implant removal and at the final follow-up: visual analog scale (VAS) pain score, American Shoulder and Elbow Surgeons (ASES) score, Shoulder Rating Scale of the University of California, Los Angeles (UCLA), Constant-Murley score, and range of motion.ResultsTwenty-one patients with a mean age of 64 years were included. Bone union was achieved within 12–20 weeks of the first surgery in all patients. Implant removal was performed between 13 and 22 weeks after surgery. At the final follow-up, the mean VAS pain score, forward flexion, abduction, external rotation, internal rotation, ASES score, UCLA score, and Constant-Murley score were significantly better when compared to outcomes shortly before implant removal (p < 0.001, p < 0.001, p < 0.001, p = 0.008, p = 0.003, p < 0.001, p < 0.001, and p < 0.001, respectively).ConclusionsThe 3.5-mm locking hook plate provided sufficient stability and led to satisfactory clinical and radiological outcomes for isolated GT fractures. However, the hook plate may irritate the rotator cuff, and postoperative stiffness may be inevitable. Therefore, second surgery for implant removal is necessary after bone union is achieved.

Ultrasound-guided Arthroscopic Tuberoplasty for Greater Tuberosity Malunion: A Case Report

Background: Greater Tuberosity (GT) malunion can lead to impingement against the acromion, resulting in pain, stiffness, and weakness of the rotator cuff. For patients with lesser degrees of displacement, partial removal of the GT with rotator cuff repair (tuberoplasty) under fluoroscopic guidance is considered. Case report: A sixty-five year old female fell from a standing height and suffered a minimally displaced isolated GT fracture. She was conservatively managed for four months and referred to our institution due to persisting pain and stiffness. The shoulder motion was severely restricted (anterior elevation: 90°, lateral elevation: 45°, external rotation with the arm at side: 25°, hand behind back: 4th lumber vertebrae) and pain aggravated especially when laterally elevated. Plain radiography and computed tomography showed small superiorly malunited GT and magnetic resonance imaging showed no rotator cuff pathology. Ultrasound images showed impingement of the GT against the acromion when laterally elevated. Arthroscopic excision of the malunited GT and rotator cuff repair along with capsular release and acromioplasty was performed under ultrasound guidance. The ultrasound images were simultaneously delineated to the arthroscopic monitor. Dynamic evaluation of the reshaped GT passing under the acromion was possible. Conclusion: Intraoperative use of ultrasound during arthroscopic tuberoplasty offers advantages over fluoroscopic guidance concerning control of the amount of bone resection and dynamic evaluation between the GT and the acromion in addition to the problems of radiation and space-occupying devices.

Le suivi radiographique des fractures isolées du tubercule majeur huméral conduit-il à un changement des recommandations thérapeutiques ? Résultats d’une enquête en ligne

IntroductionIt is common practice to obtain follow-up radiographs of non-operatively treated isolated greater tuberosity (GT) fractures 1 to 2 weeks after trauma. However, the majority of non-operatively treated GT fractures remain stable and do not require reconsideration of the initial treatment decision. Radiological follow-up therefore might be unnecessary. Our primary objective was to study whether radiological follow-up changes the initial treatment recommendation, hypothesizing no change. Materials and methodsRadiographs of 25 patients diagnosed with an isolated GT fracture were selected from our hospital database and presented on a web-based platform. Sixty-eight trauma- and orthopedic surgeons evaluated these radiographs. First, the radiographs directly post-trauma and then, in random order, the radiographs 5–14 days post-trauma alongside the first radiographs. Each observer evaluated each set of radiographs once. The observers answered which treatment they would recommend (non-operative/operative), and how certain they were about their advice (absolutely certain, certain, some doubt, very uncertain). Recommendation-consistency and inter-observer agreement are presented as percentages and intra class correlation coefficients (ICC). ResultsOverall, 84 % (95 % CI 82.1–85.8) of treatment recommendations was unchanged after evaluation of the second radiograph. Agreement within each observer ranged from 60 to 98 %. The mean proportion of patients about whom the observers were (absolutely) certain of their recommendation increased from 70 % at the first evaluation to 83 % at the second evaluation (12.8; 95 % CI 9.8–15.9). Furthermore, the ICC between the surgeons improved from 0.37 (95 % CI 0.26–0.54) for the first evaluation to 0.60 (95 % CI 0.47–0.74) for the second. ConclusionIn 16 % of the patients, the treatment recommendation for an isolated GT fracture changed after the evaluation of radiographs 1 to 2 weeks post-trauma. In addition, surgeons were more certain about their recommendation and there was less inter-observer variation. Radiological follow-up of a non-operatively treated isolated GT fracture therefore seems justifiable. Level of evidenceIII, diagnostic study.

Follow-up radiographs in isolated Greater Tuberosity fractures lead to a change in treatment recommendation; an online survey study

IntroductionIt is common practice to obtain follow-up radiographs of non-operatively treated isolated greater tuberosity (GT) fractures 1 to 2 weeks after trauma. However, the majority of non-operatively treated GT fractures remain stable and do not require reconsideration of the initial treatment decision. Radiological follow-up therefore might be unnecessary. Our primary objective was to study whether radiological folow-up changes the initial treatment recommendation, hypothesizing no change. Materials and methodsRadiographs of 25 patients diagnosed with an isolated GT fracture were selected from our hospital database and presented on a web-based platform. Sixty-eight trauma- and orthopedic surgeons evaluated these radiographs. First the radiographs directly post-trauma and then, in random order, the radiographs 5-14 days post-trauma alongside the first radiographs. Each observer evaluated each set of radiographs once. The observers answered which treatment they would recommend (non-operative/operative), and how certain they were about their advice (absolutely certain, certain, some doubt, very uncertain). Recommendation-consistency and inter-observer agreement are presented as percentages and intra class correlation coefficients (ICC). ResultsOverall, 84% (95% CI 82.1–85.8) of treatment recommendations was unchanged after evaluation of the second radiograph. Agreement within each observer ranged from 60 to 98%. The mean proportion of patients about whom the observers were (absolutely) certain of their recommendation increased from 70% at the first evaluation to 83% at the second evaluation (12.8; 95% CI 9.8–15.9). Furthermore, the ICC between the surgeons improved from 0.37 (95% CI 0.26–0.54) for the first evaluation to 0.60 (95% CI 0.47–0.74) for the second. ConclusionIn 16% of the patients the treatment recommendation for an isolated GT fracture changed after the evaluation of radiographs 1 to 2 weeks post-trauma. In addition, surgeons were more certain about their recommendation and there was less inter-observer variation. Radiological follow-up of a non-operatively treated isolated GT fracture therefore seems justifiable. Level of evidenceIII, diagnostic study.

The incidence of occult and missed surgical neck fractures in patients with isolated greater tuberosity fracture of the proximal humerus

BackgroundOccult and missed surgical neck fractures can be found in patients diagnosed with isolated greater tuberosity (GT) fracture during the follow up period. The purpose of this study was to retrospectively assess the incidence rate of occult and missed surgical neck fractures in those initially diagnosed with isolated GT fracture.MethodsRecords of patients diagnosed as having an isolated GT fracture were retrieved from a database in a medical center. Two senior orthopedic surgeons blindly reviewed all images of these patients three times to classify GT fracture types (split, avulsion and depression types), and recorded any surgical neck fractures found. Then a meeting was help to confirm the fracture types and presence of surgical neck fracture.ResultsOccult surgical neck fractures were found in 5 out of 68 (7.4%) patients, whereas missed surgical neck fractures were found in 3 out of 68 (4.4%) patients. In total, 32 patients had split type GT fracture, 32 had avulsion type and 4 had depression type. For those with occult surgical neck fractures, 7 had the split type GT fracture, while the remaining one had the avulsion type. Although the proportion of occult surgical neck fracture was higher in the split-type GT fracture (21.9%) than in the avulsion-type GT fracture (3.1%), the difference was not statistically significant (p = 0.056).ConclusionOccult humeral surgical neck fractures occurred in 7.4% of isolated greater tuberosity fractures after re-evaluation, while missed humeral surgical neck fractures occurred in 4.4%.

Utility of MRI in the Evaluation of Acute Greater Tuberosity Proximal Humeral Fractures.

Background:Understanding soft tissue injury patterns associated with greater tuberosity (GT) fractures may help clinicians provide guidance to patients.Hypothesis:Evaluating magnetic resonance imaging (MRI) findings in patients with suspected isolated GT fractures will help elucidate the role of MRI in the diagnosis and treatment of these patients.Study Design:Case series; Level of evidence, 4.Methods:We performed a retrospective review of medical records from 2010 to 2014 for patients presenting with acute isolated GT fractures and MRI. Uncomplicated and delayed recovery groups were established according to the need for delayed procedural intervention or persistent symptoms past last recorded follow-up. Multivariate regression analysis was used to analyze the relationships between MRI findings and delayed recovery.Results:A total of 32 patients met the inclusion criteria (mean age, 47 years [range, 24-88 years]; mean follow-up, 30 weeks [range, 33 days–4 years]). There was no significant difference in the estimation of fracture displacement as measured on radiography and compared with MRI (radiography, 2.8 mm; MRI, 3.5 mm; P = .16). There was a high incidence of full-thickness rotator cuff tears (9%), partial-thickness rotator cuff tears (72%), partial biceps tendon tears (41%), and labral tears (50%). Presence of biceps pathology or partial-thickness rotator cuff tear was predictive of delayed recovery in a multivariate model.Conclusion:There is a high incidence of soft tissue injury found by MRI following GT fracture. MRI did not appreciably change the measure of displacement of the fracture fragment. In the multivariate analysis, presence of a partial-thickness rotator cuff tear or biceps tendon injury was associated with delayed recovery.

Isolated fractures of the greater tuberosity: When are they treated conservatively?: Abaseline study.

BackgroundThis study analyzed the indications for conservative management of isolated greater tuberosity (GT) fractures. The rate of secondary interventions for failed conservative treatment was also assessed.MethodsA retrospective data evaluation of isolated GT fractures was performed from the clinical database of two level-I trauma centers from January 2010 to June 2017. Conservatively treated GT fractures were identified and subdivided according to etiology, morphology, and amount of initial displacement. Secondary surgical interventions were recorded and subcategorized into fracture-associated interventions and interventions for associated soft tissue lesions.ResultsWe identified 114 fractures. Nine cases were excluded because patients refused surgery or their comorbidities ruled it out. Only two of the remaining 105 patients had an initial displacement >3 mm. All other GT fractures (n = 103, 98%) were not displaced or only slightly displaced (0–3 mm). The fracture was associated with an anterior shoulder dislocation in 39 cases (37%); 17 patients (16.2%) underwent surgery after primary conservative treatment. Four of these 17 patients presented with a secondary displacement of the GT fragment. In all other cases (76.5%), an associated soft tissue lesion necessitated revision surgery. Young age, anterior shoulder dislocation, and concomitant injuries were risk factors for revision surgery after primary conservative treatment.ConclusionSecondary interventions are required more frequently after shoulder dislocation. Surgery is most likely required for associated soft tissue lesions rather than for secondary displacements. Thus, detailed physical examination and magnetic resonance imaging should be used to screen for concomitant soft tissue injuries accompanying GT fractures to prevent revision surgeries.

Hook Plate Fixation for Isolated Greater Tuberosity Fractures of the Humerus

BACKGROUND: The purpose of this study was to investigate the outcomes after fixation using a 3.5-mm locking compression plate (LCP) hook plate for isolated greater tuberosity (GT) fractures of the proximal humerus.METHODS: We evaluated the postoperative radiological and clinical outcomes in nine patients who were followed up at least 1 year with isolated GT fractures. Using the deltopectoral approach, we fixed the displaced GT fragments with a 3.5-mm LCP hook plate (Synthes, West Chester, PA, USA). Depending on the fracture patterns, the hook plate was fixed with or without augmentation using either tension suture or suture anchor fixation.RESULTS: All the patient showed successful bone union. The mean time-to-union was 11 weeks. The radiological and clinical outcomes at the final follow-up were generally satisfactory. The mean visual analogue scale for pain, the University of California at Los Angeles score, the American Shoulder and Elbow Surgeons score, and the subjective shoulder value were 1.4, 30.3, 84.3, and 82.2%, respectively. The mean active forward flexion, abduction, external rotation, and internal rotation of the shoulder were 156.7°, 152.2°, 61.1°, and the 10th thoracic vertebral level, respectively. Only one patient presented with a postoperative complication of shoulder stiffness. The patient was treated through arthroscopic capsular release on the 5th postoperative month.CONCLUSIONS: We conclude that fixation using 3.5-mm LCP hook plates for isolated GT fractures of the proximal humerus is a useful treatment method that provides satisfactory clinical and radiological outcomes.

An alternative technique for greater tuberosity fractures: use of the mesh plate.

Isolated greater tuberosity (GT) fractures (AO 11-A1) tend to occur in the younger patient population and are poorly managed by most precontoured proximal humerus locking plates. The goal of this study was to identify and assess an alternative treatment strategy for greater tuberosity fractures. A retrospective review of all cases of isolated greater tuberosity fractures treated with a 2.4/2.7 mesh plate (Synthes) between 2010 and 2015 was conducted. Patient demographics, operative reports, and clinical notes were reviewed. The time to radiographic union was assessed. Clinical outcomes were retrieved from patients at their follow-up visits or via mailed Disabilities of the Arm, Shoulder, Hand (DASH) questionnaires. Ten patients with isolated GT fractures treated with mesh plating were identified with an average age of 47.1years. The average radiographic follow-up was 7.2months and the average clinical follow-up was 8.0months. The mean time to union was 8.5weeks. Two patients underwent elective hardware removal. The mean DASH at final follow-up was 28.2 (±22.4), while the mean DASH work was 13.6 (±19.1). We have identified a viable alternative treatment option for the surgical management of isolated greater tuberosity fractures using a mesh plate that can be contoured to the patient's anatomy. Surgeons should be aware of this option for select patients.

Fractures of the greater tuberosity of the humerus: a study of associated rotator cuff injury and atrophy.

This is a retrospective prognostic study on soft tissue injury following isolated greater tuberosity (GT) fractures of the proximal humerus with respect to the relationship between rotator cuff tears and GT displacement. Forty-three patients with isolated GT fractures were recruited and evaluated with a standardized interview and physical examination, quality of life and shoulder function questionnaires (Western Ontario Rotator Cuff Index, SF-12 Version 2, Constant, Quick-Disabilities of the Arm, Shoulder and Hand, Visual Analogue Scale), standard shoulder radiographs and an ultrasound. The main outcome measurements were: incidence of rotator cuff tears and atrophy, biceps pathology and sub-acromial impingement; superior displacement of the GT fragment; and questionnaire scores. Mean age was 57 years (31 years to 90 years) with a follow-up of 2.4 years (0.8 years to 6.8 years). In total, 16% had a full rotator cuff tear and 57% showed subacromial impingement on ultrasound. Full rotator cuff tears and supraspinatus fatty atrophy significantly correlated with decreased function and abduction strength. Significant atrophy (>50%) of the supraspinatus and infraspinatus, without a rotator cuff tear, was correlated with the worst function in the presence of a residual displacement of the greater tuberosity at the last-follow-up (7 mm). Residual displacement, full rotator cuff tear and muscle atrophy are associated with the worst outcomes. Soft tissue imaging could benefit patients with an unfavourable outcome after a GT fracture to treat soft tissue injury.

Delayed Migration of Greater Tuberosity Fractures Associated With Anterior Shoulder Dislocation.

Treatment of greater tuberosity (GT) fractures occurring during anterior shoulder dislocation generally consists of initial closed reduction of the shoulder. Undisplaced fractures are treated conservatively, whereas displaced fractures generally undergo surgical management. Our hypothesis is that many well-reduced GT fractures will migrate. The primary goal of this study is to evaluate the outcomes of GT fractures associated with shoulder dislocation to optimize their management. Retrospective review with prospective outcomes. Tertiary Level 1 trauma center. A total of 55 patients with anterior shoulder dislocation and GT fractures were identified. A matched cohort of isolated GT fractures was also identified. Closed reduction versus open reduction with or without fixation. Radiographs were evaluated for initial displacement, reduction, Hill-Sachs lesion, and subsequent displacement. Patients were evaluated using the Constant and quick DASH scores at a minimum of 1 year of follow-up. A majority of patients received initial closed reduction, with acceptable reduction of the tuberosity in 85%. With closed reduction, migration of the GT was seen in 9 cases (16%). In younger patients (<70 years), the failure rate increased to 26%. Displacement of the GT was 5.6 times more likely with dislocation than without. Patients with migration were only operated on in 33% of cases, mostly because of late presentation. Treatment of GT fractures occurring with anterior shoulder dislocation is complex. Although outcomes with nonoperative treatment are generally acceptable, a significant proportion of these patients will have tuberosity migration, which may impact function. Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Accurate Measurement of Greater Tuberosity Displacement Without Computed Tomography

Residual displacement of greater tuberosity (GT) fractures has been shown to negatively affect shoulder function. However, accurate measurement of GT displacement remains a problem with errors up to 13 mm on plain radiography (XR). A new GT ratio for measuring fracture displacement on XR is described, validated, and correlated with computed tomography (CT) and surgical decision making. A retrospective review of shoulder radiographs was performed from 2007 to 2010 to identify all cases of isolated GT fractures with both XR and CT. The GT ratio was performed on all XR and correlated with superior GT displacement measured on CT. The GT ratio was then tested for accuracy of surgical decision using 5-mm superior displacement on CT as the cutoff. Finally, the inter- and intraobserver reliabilities of the GT ratio were calculated and compared with the Neer and Arbeitsgemeinschaft fur Osteosynthesefragen (AO) classifications. Forty cases of acute GT fractures with XR and CT were identified. The GT ratio correlated very well with superior displacement on CT (Pearson correlation = 0.852, P < 0.01) and accurately classified GT fractures as "surgical" (n = 9, 23%) or "nonsurgical" (n = 31, 77%). GT ratios ≤0.00 were nonsurgical, ≥0.50 were surgical, and 0.00-0.50 warranted further imaging (P < 0.01). The GT ratio performed as well as or better than the AO and Neer classifications for inter- and intraobserver reliabilities. The GT ratio described in this study correlates very well with CT for superior GT fracture displacement. It involves significantly less radiation and accurately classifies GT fractures as nonsurgical (ratio < 0.00), surgical (ratio > 0.50), or as benefiting from further imaging (0.00-0.50). It performs as well or better than the Neer or AO classification. Diagnostic Level II. See Instructions for Authors for a complete description of levels of evidence.

A Novel Hybrid Fixation Technique for Osteosynthesis of Isolated Greater Tuberosity Fractures of the Proximal Humerus

A Novel Hybrid Fixation Technique for Osteosynthesis of Isolated Greater Tuberosity Fractures of the Proximal Humerus

The Surgical Outcomes of Isolated Greater Tuberosity Fractures of the Proximal Humerus Fixed with the Spring Plate

159 통신저자:변 영 수 대구시 동구 신암동 576-31 대구파티마병원 정형외과 Tel:053-940-7320ᆞFax:053-940-7417 E-mail:fatimaos@unitel.co.kr *본 논문의 요지는 2008년도 대한골절학회 추계학술대회에서 발표되었음. 접수: 2009. 1. 22 심사 (수정): 2009. 4. 20 게재확정: 2009. 6. 30 Address reprint requests to:Young-Soo Byun, M.D. Department of Orthopaedic Surgery, Daegu Fatima Hospital, 576-31, Sinam-dong, Dong-gu, Daegu 701-600, Korea Tel:82-53-940-7320ᆞFax:82-53-940-7417 E-mail:fatimaos@unitel.co.kr 상완골 대결절 단독 골절의 스프링 금속판을 이용한 수술적 치료 결과

Management of a Patient With an Isolated Greater Tuberosity Fracture and Rotator Cuff Tear

Management of a Patient With an Isolated Greater Tuberosity Fracture and Rotator Cuff Tear