Anterior Traumatic Shoulder Dislocation Associated With Displaced Greater Tuberosity Fracture: The Necessity of Operative Treatment

Dimakopoulos, P.; Panagopoulos, Andreas; Kasimatis, George; Syggelos, Spiros A; Lambiris, E.

doi:10.1097/bot.0b013e3180316cda

Cited by 34 publications

(22 citation statements)

References 21 publications

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“…In isolated two-part fractures of the greater tuberosity, the displaced tuberosity is reduced to its anatomical position, thus avoiding a mechanical block to abduction of the shoulder or obstruction of external rotation because of posterior displacement of the greater tuberosity. Our preference is for suture fixation of the greater tuberosity fragment in patients with associated dislocation of the shoulder, regardless of the extent of its postreduction displacement 6 . Our decision to internally fix the greater tuberosity in its anatomical position is based on the nature of the injury rather than the degree of postreduction displacement.…”

Section: Critical Concepts Potential Risks and Pitfalls (Continued)mentioning

confidence: 99%

Transosseous Suture Fixation of Proximal Humeral Fractures

Dimakopoulos

Panagopoulos

Kasimatis

2009

Journal of Bone and Joint Surgery

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Section: Critical Concepts Potential Risks and Pitfalls (Continued)mentioning

confidence: 99%

Transosseous Suture Fixation of Proximal Humeral Fractures

Dimakopoulos

Panagopoulos

Kasimatis

2009

Journal of Bone and Joint Surgery

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“…Several fixation techniques using screw, tension banding, or transosseous suture have been described for reduction and internal fixation of greater tuberosity fractures [7,9,15]. Despite the reported satisfactory results [8,9,15], few techniques can provide adequate fixation of the fragments and accurate restoration of the tuberosity-head relation for comminuted fractures [3]. With further development of arthroscopy techniques, arthroscopic reduction and fixation have been used in the treatment of greater tuberosity fractures.…”

Section: Introductionmentioning

confidence: 99%

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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“…Bahrs et al [27] associated avulsion fractures of the GT during anterior shoulder dislocation at 10-30% of cases. The overall incidence of displaced GT fracture as part of an anterior dislocation in a series of 544 cases of proximal humeral fractures that underwent operative treatment in our clinic between 1993 and 2002 was 6.6% [28]. The suggested mechanism is impingement of the GT against the acromion and the glenoid rim presented as a complete form of Hill-Sachs lesion.…”

Section: Discussionmentioning

confidence: 99%

Irreducible Anterior Shoulder Dislocation with Interposition of the Long Head of the Biceps and Greater Tuberosity Fracture: A Case Report and Review of the Literature

Pantazis¹,

Panagopoulos²,

Tatani³

et al. 2017

TOORTHJ

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Background:Failure of closed manipulative reduction of an acute anterior shoulder dislocation is seldom reported in the literature and is usually due to structural blocks such as soft tissue entrapment (biceps, subscapularis, labrum), bony fragments (glenoid, greater tuberosity) and severe head impaction (Hill-Sachs lesion).Case report:We present a case of an irreducible anterior shoulder dislocation in a 57-year-old male patient after a road-traffic accident. He had severe impaction of the head underneath glenoid rim and associated fracture of the greater tuberosity. Closed reduction performed in the emergency room under sedation and later at the theatre under general anaesthesia was unsuccessful. Open reduction using the dectopectoral approach revealed that the reason for obstruction was the posterolateral entrapment of the biceps tendon between the humeral head and the tuberosity fragment. Reduction was achieved after subscapularis tenotomy and opening of the joint; the tuberosity fragment was fixed with transosseous sutures and the long head of the biceps tendon was tenodesized. The patient had an uneventful postoperative recovery and at his last follow up, 12 months postoperatively, he had a stable joint, full range of motion and a Constant score of 90.Conclusion:A comprehensive literature review revealed 22 similar reports affecting a total of 30 patients. Interposition of the LHBT alone or in combination with greater tuberosity fracture was the most common obstacle to reduction, followed by subscapularis tendon interposition and other less common reasons. Early surgical intervention with open reduction and confrontation of associated injuries is mandatory for a successful outcome.

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Anterior Traumatic Shoulder Dislocation Associated With Displaced Greater Tuberosity Fracture: The Necessity of Operative Treatment

Cited by 34 publications

References 21 publications

Transosseous Suture Fixation of Proximal Humeral Fractures

Transosseous Suture Fixation of Proximal Humeral Fractures

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

Irreducible Anterior Shoulder Dislocation with Interposition of the Long Head of the Biceps and Greater Tuberosity Fracture: A Case Report and Review of the Literature

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