Effect of displacement of fractures of the greater tuberosity on the mechanics of the shoulder

Bono, Christopher M.; Renard, Régis; Levine, Richard G.; Levy, Andrew

doi:10.1302/0301-620x.83b7.10516

Cited by 107 publications

(35 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…16 Bono et al 5 showed that the abduction force is significantly increased by 16% and 27% by superior displacements of 0.5 and 1 cm, respectively, while combined superior and posterior displacement of 1 cm gives an increase in force of 29%. Thus, the objectives of surgical treatment are to prevent painful malunion and avoid alteration of the rotator cuff attachment to the proximal humerus.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

mentioning

confidence: 99%

See 1 more Smart Citation

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

Lin

Hong

Jou

et al. 2011

Journal Orthopaedic Research

View full text Add to dashboard Cite

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...

show abstract

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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

Lin

Hong

Jou

et al. 2011

Journal Orthopaedic Research

View full text Add to dashboard Cite

show abstract

“…Posterosuperior displacement of the greater tuberosity of more than 5 mm from the anatomic position can result in malunion and impingement of the shoulder due to an altered rotator cuff insertion site influencing the motion in the glenohumeral joint (Bono et al 2001). The recommendation of Neer (2006) to treat displacements of the tuberosity of less than 1 cm nonoperatively has been revised, and in the current literature it is recommended that surgical fixation be used for fractures with more than 5 mm of displacement in the general population or more than 3 mm of displacement in active patients with frequent overhead activity (Park et al 1997, George 2007).…”

Section: Discussionmentioning

confidence: 99%

Isolated fractures of the greater tuberosity of the proximal humerus

Mattyasovszky¹,

Burkhart²,

Ahlers³

et al. 2011

Acta Orthopaedica

View full text Add to dashboard Cite

Background and purpose The diagnosis and treatment of isolated greater tuberosity fractures of the proximal humerus is not clear-cut. We retrospectively assessed the clinical and radiographic outcome of isolated greater tuberosity fractures.Patients and methods 30 patients (mean age 58 (26–85) years, 19 women) with 30 closed isolated greater tuberosity fractures were reassessed after an average follow-up time of 3 years with DASH score and Constant score. Radiographic outcome was assessed on standard plain radiographs.Results 14 of 17 patients with undisplaced or slightly displaced fractures (≤ 5 mm) were treated nonoperatively and had good clinical outcome (mean DASH score of 13, mean Constant score of 71). 8 patients with moderately displaced fractures (6–10 mm) were either treated nonoperatively (n = 4) or operatively (n = 4), with good functional results (mean DASH score of 10, mean Constant score of 72). 5 patients with major displaced fractures (> 10 mm) were all operated with good clinical results (mean DASH score of 14, mean Constant score of 69). The most common discomfort at the follow-up was an impingement syndrome of the shoulder, which occurred in both nonoperatively treated patients (n = 3) and operatively treated patients (n = 4). Only 1 nonoperatively treated patient developed a non-union. By radiography, all other fractures healed.Interpretation We found that minor to moderately displaced greater tuberosity fractures may be treated successfully without surgery.

show abstract

“…The deltoid force required for abduction [4] is significantly higher when the greater tuberosity is displaced more than 0.5 cm.…”

Section: Introductionmentioning

confidence: 93%

Arthroscopic treatment for malunions of the proximal humeral greater tuberosity

Martı́nez

Calvo

Díez-Domingo

et al. 2009

International Orthopaedics (SICOT)

View full text Add to dashboard Cite

The purpose of this article was to report an arthroscopic treatment method for greater tuberosity malunion. Eight patients with malunion of the greater tuberosity were treated by arthroscopic acromioplasty, detachment of rotator cuff, tuberoplasty of the greater tuberosity and repair of the rotator cuff. On the basis of the UCLA rating scale, the overall score increased from 11.1 (range 9-14) to 30.2 (range 25-35) postoperatively, with one excellent result, six good results, and one poor result. All patients had less pain than preoperatively. Full activity level was achieved in two patients, five patients had only slight functional restriction, and one patient had mild limitation in activities of daily living. Seven patients returned to their previous occupations without restrictions. One patient did not return to work because of residual upper extremity weakness. We conclude that arthroscopic tuberoplasty is a good method for the treatment of greater tuberosity malunion.

show abstract

Effect of displacement of fractures of the greater tuberosity on the mechanics of the shoulder

Cited by 107 publications

References 15 publications

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

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

Isolated fractures of the greater tuberosity of the proximal humerus

Arthroscopic treatment for malunions of the proximal humeral greater tuberosity

Contact Info

Product

Resources

About