Arthroscopic Fixation for Displaced Greater Tuberosity Fracture Using the Suture-Bridge Technique

Kim, Kyung-Cheon; Rhee, Kyehan; Shin, Hyun Dae; Kim, Young-Mo

doi:10.1016/j.arthro.2007.05.003

Cited by 50 publications

(38 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In the cadaveric model of GT fracture, our results suggest that no significant differences exist between the double-row suture anchor fixation 6,10,13 and suture-bridge technique 9,11,12 in force to 5 mm displacement and maximal failure load, while the loading force of the two-screw fixation 14,15 was smaller in all tests (loading force of 3 and 5 mm displacement and failure load). However, the suture-bridge technique had the highest value in the loading force of 3 mm displacement.…”

Section: Discussionmentioning

confidence: 74%

“…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][10][11][12][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.…”

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: 74%

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

“…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%

“…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%

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

View full text Add to dashboard Cite

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.

show abstract

“…We previously used fascia lata femoris as a patch graft but encountered difficulty associated with tendon-to-bone healing because of postoperative recurrence of tears at the footprint on the side of the greater tuberosity. Thus, considering the good results obtained by fixing bone fragments of the fracture of the greater tuberosity using the suture-bridge technique, 5 we started using the new patch graft reported in this article. The advantages of this technique are as follows: (1) There is no risk of rejection or other adverse reactions because an autograft is used.…”

Section: Patch Augmentation Of Rotator Cuff Repairsmentioning

confidence: 99%

A New Technique for Patch Augmentation of Rotator Cuff Repairs

Mihara

Ono

Inoue

et al. 2014

Arthroscopy Techniques

View full text Add to dashboard Cite

Massive rotator cuff tears defying primary repair have been treated with debridement, arthroscopic subacromial decompression, partial repair, muscle-tendon transfer, and joint prosthesis, among other techniques. However, the treatment results have not been satisfactory compared with those of small-to medium-sized rotator cuff tears; each procedure has its merits and demerits, and currently, there is no single established method. For massive rotator cuff tears defying primary repair, the arthroscopic patch graft procedure has been reported as an effective surgical procedure, and this procedure is chosen as the first-line treatment in our department. In this procedure, suture anchors are generally used to fix the patch graft to the footprint on the side of the greater tuberosity. However, tendon-to-bone healing is frequently difficult to achieve, and bone-to-bone healing seems more advantageous for the repair of the rotator cuff attachment site. To improve the results of treatment, a new patch graft procedure was developed, in which the iliotibial ligament with bone was collected at Gerdy's tubercle and the bone was anchored to the footprint on the side of the greater tuberosity. With this procedure, excellent results were obtained, although only short-term results are available at present. The technique and its results so far are reported. Despite the development of instruments and techniques in arthroscopic surgery, reconstruction of massive rotator cuff tears continues to be a challenge, with a high retear rate.1,2 Strengthening with a patch graft in such cases is an effective reconstructive procedure that can be expected to produce biological and biomechanical improvements. Recently, the use of several types of biological patches has been reportedd for instance, swine small intestinal mucous membrane (Restore Implant; DePuy, Warsaw, IN), human skin (GraftJacket; Wright Medical Technology, Arlington, TN), bovine skin (Tissue Mend; TEI Biosciences, Boston, MA), 3 and autologous fascia lata femoris. With these tissues, however, healing at the attachment site on the greater tuberosity of the rotator cuff might be difficult to achieve. To achieve bone-to-bone healing at the rotator cuff attachment site, the iliotibial ligament with bone as a patch graft was develoed as an alternative procedure. With the use of this patch, we believe that the purposes of patch strengthening could be achieved, including (1) increasing early strength, (2) providing a bridge for cellular ingrowth to improve the biological environment, and (3) not inducing a foreign-body reaction, thereby not interfering with the healing process.Our objective is to report the operative technique and describe the results of treatment because excellent short-term results are now available. The technique is demonstrated in Video 1. Surgical TechniqueThe patient underwent arthroscopy under general anesthesia in the beach-chair lateral-traction position. A secondary lesion in the scapulohumeral joint, if detected, was treated simultaneously. The tr...

show abstract

Arthroscopic Fixation for Displaced Greater Tuberosity Fracture Using the Suture-Bridge Technique

Cited by 50 publications

References 11 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

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

A New Technique for Patch Augmentation of Rotator Cuff Repairs

Contact Info

Product

Resources

About