Arthroscopic Fixation Technique for Comminuted, Displaced Greater Tuberosity Fracture

Ji, Jong‐Hun; Shafi, Mohamed; Song, In Soo; Kim, Young‐Yul; McFarland, Edward G.; Moon, Chang Yun

doi:10.1016/j.arthro.2009.09.011

Cited by 76 publications

(76 citation statements)

References 29 publications

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“…This is in accordance with previous studies which indicated that arthroscopic double-row suture anchor fixation needed a longer surgical time and a high learning curve linked to the shoulder arthroscopic technique [19,23,28]. In our opinion, this difference in surgical time is important because a longer surgical time may correspondingly increase potential risk of the surgery.…”

Section: Discussionsupporting

confidence: 92%

“…The results of ORIF described previously are favorable [9,12]. However, because of the biomechanical advantage of double-row suture anchor fixation [31], this technique has been used in open and arthroscopic fixation of greater tuberosity fractures to restore the bone-tendon transition area accurately [3,17,19,22,27,28]. Even with various surgical techniques available, it is difficult for surgeons to choose which to use, since, to our knowledge, no studies have directly compared these approaches.…”

Section: Discussionmentioning

confidence: 99%

“…In our opinion, this difference in surgical time is important because a longer surgical time may correspondingly increase potential risk of the surgery. Some authors have reported that it is not technically possible for arthroscopic double-row suture anchor fixation to reduce and fix severely displaced fracture fragments adequately, and therefore an open procedure is preferred [3,19]. Additionally, arthroscopic double-row suture anchor fixation may damage the rotator cuff, as the medial anchors are inserted through the intact cuff attached to the greater tuberosity fragment [17,19].…”

Section: Discussionmentioning

confidence: 99%

“…Some authors have reported that it is not technically possible for arthroscopic double-row suture anchor fixation to reduce and fix severely displaced fracture fragments adequately, and therefore an open procedure is preferred [3,19]. Additionally, arthroscopic double-row suture anchor fixation may damage the rotator cuff, as the medial anchors are inserted through the intact cuff attached to the greater tuberosity fragment [17,19]. As for ORIF, several alternative surgical techniques are available for use such as a tension band which may have fewer differences compared with the arthroscopic technique, however, it was reported in a biomechanical study that a locking plate provides superior fixation of a greater tuberosity fracture compared with tension bands [10].…”

Section: Discussionmentioning

confidence: 99%

“…One example is reduction of a greater tuberosity fracture using arthroscopic guidance and percutaneous screw fixation [4,30]. Arthroscopic double-row suture anchor fixation, previously used in rotator cuff repair, has been reported for the treatment of greater tuberosity fractures [17,19,22,27,28]. This technique improves the initial repair strength and provides a tendon-bone interface better suited for biologic healing and restoration of the normal anatomy [17,18,20,24].…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Is Arthroscopic Technique Superior to Open Reduction Internal Fixation in the Treatment of Isolated Displaced Greater Tuberosity Fractures?

Liao¹,

Zhang²,

Li³

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Arthroscopic double-row suture-anchor fixation and open reduction and internal fixation (ORIF) are used to treat displaced greater tuberosity fractures, but there are few data that can help guide the surgeon in choosing between these approaches. Questions/Purposes We therefore asked: (1) Is there a difference in surgical time between arthroscopic doublerow suture anchor fixation and ORIF for isolated displaced greater tuberosity fractures? (2) Are there differences in the postoperative ROM and functional scores between arthroscopic double-row suture anchor fixation and ORIF for isolated displaced greater tuberosity fractures? (3) Are there differences in complications resulting in additional operations between the two approaches?Methods Between 2006 and 2012, we treated 79 patients surgically for displaced greater tuberosity fractures. Of those, 32 (41%) were considered eligible for our study based on inclusion criteria for isolated displaced greater tuberosity fractures with a displacement of at least 5 mm but less than 2 cm. During that time, we generally treated patients with displaced greater tuberosity fractures with a displacement greater than 1 cm or with a fragment size greater than 393 cm with open treatment, and patients with displaced greater tuberosity fractures with a displacement less than 1 cm or with a fragment size less than 393 cm with arthroscopic treatment. Fifty-three underwent open treatment based on those indications, and 26 underwent arthroscopic treatment, of whom 17 (32%) and 15 (58%) were available for followup at a mean of 34 months (range, 24-28 months). All patients with such fractures identified from our institutional database were treated by these two approaches and no other methods were used. Surgical time was defined as the time from initiation of the incision to the time when suture of the incision was finished, and was determined by an observer with a stopwatch. Patients were followed up in the outpatient department at 6, 12, and 24 weeks, and every 6 month thereafter. Radiographs showed optimal reduction immediately after surgery and at every followup. Radiographs were obtained to assess fracture healing. Patients were followed up for a mean of 34 months (range, 24-48 months). At the last followup, ROM, VAS score, and American Shoulder and Elbow Surgeons (ASES) score were used to evaluate clinical outcomes. All these data were retrieved from our institutional database through chart review. Complications were assessed through chart review by one observer other than the operating surgeon.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Is Arthroscopic Technique Superior to Open Reduction Internal Fixation in the Treatment of Isolated Displaced Greater Tuberosity Fractures?

Liao¹,

Zhang²,

Li³

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Suture anchor versus screw fixation for greater tuberosity fractures of the humerus—a biomechanical study

Lin

Hong

Jou

et al. 2011

Journal Orthopaedic Research

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Suture anchors and screws are commonly used for fixation of humeral greater tuberosity (GT) fractures in either arthroscopic or open surgeries, but no biomechanical studies have been performed to compare the strength of fixation constructs using these two implants. This cadaveric study aimed to compare the biomechanical strength of three different fixation constructs in the management of GT fractures: Double-Row Suture Anchor Fixation (DR); Suture-Bridge Technique using suture anchors and knotless suture anchors (SB); and Two-Screw Fixation (TS). The experimental procedure was designed to assess fracture displacement after cyclic loading, failure load, and failure mode of the fixation construct. Significant differences were found among the SB (321 N), DR (263 N), and TS (187 N) groups (SB > DR > TS, p < 0.05) in the mean force of cyclic loading to create 3 mm displacement. Regarding the mean force of cyclic loading to create 5 mm displacement and ultimate failure load, no significant difference was found between the DR (370 N, 480 N) and SB (399 N, 493 N) groups, but both groups achieved superior results compared with the TS group (249 N, 340 N) (p < 0.05). The results suggested that the suture anchor constructs would be stronger than the fixation construct using screws for the humeral GT fracture. Keywords: humeral greater tuberosity fracture; suture anchor; screw; double-row fixation; biomechanics Isolated greater tuberosity (GT) fractures of the humerus are common. The rate of incidence is $17% to 21% among proximal humeral fractures.1 GT fractures often occur in anterior shoulder dislocation or as the result of an impaction injury. Although the amount of displacement requiring operative reduction and fixation is disputed, the consequences of an untreated malunited GT fracture can be pain and limited motion.2 Current literature recommends surgical intervention in cases with >5 mm of displacement in the general population or >3 mm of displacement in active patients. 1,[3][4][5] Open surgeries or percutaneous techniques with the aid of fluoroscopy using suture anchors or screws are well accepted for the reduction and fixation of GT fractures. 1,6,7 However, the techniques continue to evolve, particularly minimally invasive and arthroscopic techniques that have the advantages of minimizing skin incision, soft tissue dissection, and associated morbidities. 8,9 The materials used for arthroscopic fixation include suture anchors 9-13 or percutaneous screws.14,15 Although both implants are commonly used for fixation in GT fractures, mechanical stability remains a major concern for early postoperative mobilization and optimal functional results. No biomechanical studies have been performed to compare the strength of fixation constructs using suture anchors or screws. Therefore, our purpose was to analyze the strength of three different fixation constructs, using suture anchors or screws, for the management of GT fractures. We hypothesized that the suture anchor configurations would provide more biomechanica...

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

Ko,

Oh,

Park

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeCurrently, 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.MethodsThis 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.ResultsFifteen 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.ConclusionsArthroscopic 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 of EvidenceLevel IV.

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Arthroscopic Fixation Technique for Comminuted, Displaced Greater Tuberosity Fracture

Cited by 76 publications

References 29 publications

Is Arthroscopic Technique Superior to Open Reduction Internal Fixation in the Treatment of Isolated Displaced Greater Tuberosity Fractures?

Is Arthroscopic Technique Superior to Open Reduction Internal Fixation in the Treatment of Isolated Displaced Greater Tuberosity Fractures?

Suture anchor versus screw fixation for greater tuberosity fractures of the humerus—a biomechanical study

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

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