Arthroscopic Reduction and Internal Fixation of Proximal Humerus Greater Tuberosity Fracture

Abstract

Proximal humerus fractures are common fractures that may occur after ground level falls or other traumatic events resulting in a direct injury to the shoulder. Depending on the fracture morphology and the age of the patient, anatomic reduction can vastly improve outcomes, especially in fracture patterns that involve the greater tuberosity. In this case example, we performed a minimally invasive, arthroscopic reduction and fixation of a proximal humerus fracture that involved significant displacement of the greater tuberosity. The technique employed is reproducible and avoids the morbidity of a large open incision while simultaneously providing compression of the fracture fragment for excellent healing potential.

Arthroscopic Reduction and Transosseous Suture Fixation of Avulsed Displaced Shoulder Greater Tuberosity Fracture

“…Studies on arthroscopic-assisted greater tuberosity fracture fixation are limited to individual case reports and case series. There have been newer techniques described using a double-row, 18 , 19 , 20 , 21 suture bridge, 22 , 23 , 24 , 25 and inverted mattress suture fixation. 26 …”

Traumatic Inferior Glenohumeral Dislocation Associated With Rotator Cuff Avulsion Fracture: Arthroscopic-Assisted Fixation: A Technical Note

“…Arthroscopic techniques allow us to reduce and fix the fracture, and satisfactory early clinical results of this technique have been reported in several studies. 5,9 Several reports on large displaced rotator cuff avulsion fracture fixation with an arthroscopic technique have also been reported. 1 In case of the large and communitive rotator cuff avulsion fragments, the lateral anchors are hard to fix compared with the conventional suture bridge technique because the lateral anchors need to be located more distally.…”

Arthroscopic Assisted Versus Open Reduction and Internal Fixation of Greater Tuberosity Fractures of the Proximal Humerus

“…Next, we create an anterior working portal through the rotator interval and treat any concurrent pathology found during the arthroscopic examination. The arthroscope is then advanced through the posterior portal to the subacromial space, and a working portal is established 2 cm lateral to the acromion's anterolateral corner [25][26][27][28]. All subacromial pathology is addressed currently.…”

“…Among the different arthroscopic reduction alternatives, no clinical evidence exists that one is superior to the other. What has been shown is that suture anchor constructions may be superior in osteoporotic or multi-fragment fractures where plates or screws may further damage the fragments [28,36].…”