Arthroscopic-assisted plate fixation for displaced large-sized comminuted greater tuberosity fractures of proximal humerus: a novel surgical technique

Park, Sang-Eun; Jeong, Jong Ju; Panchal, Karnav; Lee, Jong-Yun; Min, Hyung-Ki; Ji, Jong‐Hun

doi:10.1007/s00167-015-3805-3

Cited by 30 publications

(44 citation statements)

References 29 publications

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“…Arthroscopy allows the surgeon to directly observe the location of the fracture mass, and can also cause potential rotator cuff injury [13]. Compared with open surgery, arthroscopy can reduce the formation of scar, reduce the incidence of shoulder joint adhesion, and minimize the impact on shoulder joint function [14]. Many scholars use arthroscopic suture bridge technique to treat humeral greater tuberosity fracture [15].…”

Section: Discussionmentioning

confidence: 99%

Arthroscopic fixation of humeral greater tuberosity fracture with W-shaped suture

Lin

Fang

et al. 2020

Preprint

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Background Patients with a greater tuberosity fracture of the humerus often require surgery. Finding a less invasive and more effective way of doing surgery could help patients better. Aim To evaluate the clinical value of w-shaped suture technique under shoulder arthroscopy in the treatment of humerus greater tuberosity fractures. Methods A total of 17 patients were included in the study. These fractures are closed, and there is no neurovascular injury. These patients underwent arthroscopically assisted reduction and internal fixation. Fixation was done by means of sighting nails combined with W - shaped suture. The imaging data of the patients were collected. ASES score, Constant-Murley score and VAS score were used to evaluate the efficacy of patients. At the last follow-up (at least one year), the range of motion of the affected and contralateral shoulder joints was compared. Results All patients completed the operation successfully. The average follow-up time was 13 months. No complications such as fracture displacement, nonunion and internal fixation failure occurred during the follow-up period. According to the X-ray examination of the patients, we found that all the fractures healed smoothly, the healing time was 10–12 weeks, with an average of 11.5 weeks. After the operation, the patients complained that the shoulder joint pain was obviously relieved, and there was no influence on the activity due to shoulder joint pain and discomfort in daily life. The VAS score of these patients ranged from 0 to 3, with an average of 0.52 ± 0.73. At the last follow-up, the constant murlev score of these patients ranged from 83 to 97, with an average of 92.33 ± 7.55. The ases score of these patients 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 range of motion of the unaffected limb。 Conclusion This study demonstrates that technique of W-shaped suture can effectively fix the fracture of greater tuberosity of humerus. This technique can disperse the shear force and torsion force of suture, and increase the fixed area to promote healing, which is an effective treatment method.

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Section: Discussionmentioning

confidence: 99%

Arthroscopic fixation of humeral greater tuberosity fracture with W-shaped suture

Lin

Fang

et al. 2020

Preprint

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“…Park et.al . reported on a novel arthroscopic-assisted anatomical plate fixation technique which was found to be effective in the treatment of comminuted or large-sized GT fractures, enabled an accurate restoration of the medial footprint of the fracture, and provided an effective buttress to the large fragments [ 17 ]. On the other hand, Lin et.al .…”

Section: Discussionmentioning

confidence: 99%

Biomechanical Analysis of the Fixation Strength of a Novel Plate for Greater Tuberosity Fractures

Kaisidis

Pantos

Bochlos

et al. 2018

TOORTHJ

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Background:The incidence of isolated greater tuberosity fractures has been estimated to be 20% of all proximal humeral fractures. It is generally accepted that displaced (>5 mm) fractures should be treated surgically but the optimal surgical fixation of greater tuberosity fractures remains unclear.Objective:The goal of this study was to simulate the environment of application of a new plate system (Kaisidis plate, Fa Königsee) for fractures of greater tuberosity, and to demonstrate the stability of the plate.Methods:A Finite Element Method (FEM) simulation analysis was performed on a Kaisidis plate fixed with nine screws, in a greater tuberosity fracture model. Solid Works 2015 simulation software was used for the analysis. The Kaisidis plate is a bone plate intended for greater tuberosity fractures. It is a low profile plate with nine holes for 2,4 mm diameter locking screws, eight suture holes and additional K-wire holes for temporary fixation of the fragment.The supraspinatus tendon has the greatest effect on the fracture zone, and as such, was the primary focus for this study. For this study, we performed only linear calculations.Results:The calculations were performed in a way so that the total applied force resulted in a maximum stress of 816 N/mm2. The findings indicated that the most critical points of the Kaisidis system are the screws that are connected to the bone. The maximal force generated by the supraspinatus tendon was 784 N, which is higher than the minimal acceptable force.The results of the FEM analysis showed that the maximal supraspinatus force was 11.6% higher than the minimal acceptable force. As such, the load would exceed twice the amount of maximal force required to tear the supraspinatus tendon, before the screw or the plate would show first signs of plastic deformation.Conclusion:Based on the results of this analysis and the fulfilment of our acceptance criterion, the FEM model indicated that the strength of the Kaisidis plate exceeded that of the proposed maximum loads under non-cycli loading conditions.

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“…3,9,18) Plate fixation may be sufficient for split fractures with relatively large fracture fragments because many screws can be inserted; however, it may not be sufficient for avulsed or depressed fractures, fractures with small fragments, or those combined with comminution. 4,18) To complement this, augmentation technique using suture fixation, cerclage K-wire fixation, or suture anchor fixation are sometimes can be applied. 4,7) One of the advantages of the 3.5-mm LCP hook plates used in this study is that they can stabilize fragments of even small and comminuted fractures and, therefore, prevent loss in reduction.…”

Section: Discussionmentioning

confidence: 99%

“…4,18) To complement this, augmentation technique using suture fixation, cerclage K-wire fixation, or suture anchor fixation are sometimes can be applied. 4,7) One of the advantages of the 3.5-mm LCP hook plates used in this study is that they can stabilize fragments of even small and comminuted fractures and, therefore, prevent loss in reduction. 19) Other advantages include the buttressing effect of the plate, which supports the fracture.…”

Section: Discussionmentioning

confidence: 99%

“…2,3) The aims of surgical treatment of isolated GT fractures are to restore the normal anatomical position of the GT and to facilitate early motion exercise by achieving a rigid fixation. 4) Various fixation methods for GT fractures exist, including the transosseous suture fixation, the cannulated screw fixation, the plate fixation, the cerclage wire fixation, and the arthroscopic suture anchor fixation. 3,[5][6][7][8][9][10][11] For patients with olecranon fractures or those who have undergone olecranon osteotomies, 3.5-mm locking compression plate (LCP) hook plate (Synthes, West Chester, PA, USA) is commonly used for fixation.…”

Section: Introductionmentioning

confidence: 99%

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Hook Plate Fixation for Isolated Greater Tuberosity Fractures of the Humerus

Lee¹,

Bae

Yon³

et al. 2017

Clin Shoulder Elbow

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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.

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Arthroscopic-assisted plate fixation for displaced large-sized comminuted greater tuberosity fractures of proximal humerus: a novel surgical technique

Abstract: Retrospective clinical study, Level IV.

Cited by 30 publications

References 29 publications

Arthroscopic fixation of humeral greater tuberosity fracture with W-shaped suture

Arthroscopic fixation of humeral greater tuberosity fracture with W-shaped suture

Biomechanical Analysis of the Fixation Strength of a Novel Plate for Greater Tuberosity Fractures

Hook Plate Fixation for Isolated Greater Tuberosity Fractures of the Humerus

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