Arthroscopic Reduction and Suture Bridge Fixation of a Large Displaced Greater Tuberosity Fracture of the Humerus

Abstract

Arthroscopic fixation of a greater tuberosity (GT) avulsion fracture by suture bridge repair has been described in several articles. However, all of them have used arthroscopic fixation of a small sized GT fracture fragment or have not used purely arthroscopic techniques. In this Technical Note, the authors describe another technique for large displaced GT fracture fixation by arthroscopy only, without any metal fixation. Standard anterior, posterior, lateral, and posterolateral viewing portals are established with an accessory portal for suture anchor insertion. During intra-articular examination, an anteroinferior capsulolabral tear, upper one-third subscapularis tendon tear, and posterosuperior displaced bony fragment are detected. A subscapularis tendon was repaired by a single-row technique. After repair, medial row anchors are inserted into the bare area of infraspinatus tendon and the posterior edge of supraspinatus tendon. A 1-PDS suture is used to pass strands of fiberwire. As with the remplissage procedure, the fiberwire was passed with an 18-gauge needle. Following the acromioplasty, the medial row tightening was done by reducing the fracture fragment. After that, the lateral row anchor was inserted into the bicipital groove, completing the suture bridge technique. This technique can effectively treat other pathologies, has less radiation hazard, and results in fewer soft tissue injuries.

Arthroscopic Suture Bridge Anchor Repair of Comminuted Greater Tuberosity Fracture With Double-Row Biceps Tenodesis in Elderly Osteoporotic Patients

“… 21 Moreover, suture fixation benefits from using the strong bone–tendon junction instead of relying on the poor bone quality in elderly patients like in screw fixation. 22 Also, in very small or comminuted fracture where screws are ideal, suture fixation can be used either double row or suture bridge fixation are described. 16 , 18 , 23 Furthermore, plate fixation is usually sufficient, nevertheless, an avulsion fracture may occur through the screw hole in poor bone quality.…”

“… 16 , 18 , 23 Furthermore, plate fixation is usually sufficient, nevertheless, an avulsion fracture may occur through the screw hole in poor bone quality. 22 By using the open technique, deltoid dissection is necessary, which puts the axillary nerve at risk of injury. Also, reduction may be inadequate because of the surrounding rotator cuff.…”

Arthroscopic fixation of humeral greater tuberosity fracture with W-shaped suture

“…Compared with open surgery, arthroscopy can reduce the formation of scar, reduce the incidence of shoulder joint adhesion, and minimize the impact on shoulder joint function [14]. Many scholars use arthroscopic suture bridge technique to treat humeral greater tuberosity fracture [15]. Compared with cannulated screw fracture, suture bridge technique can effectively utilize the traction force of supraspinatus muscle to the greater tuberosity bone mass, so as to stabilize the fracture.…”

“…With the development of arthroscopy, arthroscopic treatment of humeral greater tuberosity fracture has been widely used [3]. Many materials have been used to x the fracture, including cannulated screws, Kirschner wires, plates and so on [4][5][6].…”

Plate Fixation versus Arthroscopic‐Assisted Plate Fixation for Isolated Medium‐Sized Fractures of the Greater Tuberosity: A Retrospective Study

“…Although several studies show that plate fixation achieves satisfactory clinical outcomes in the treatment of isolated displaced fractures of the greater tuberosity, it is commonly associated with a high risk of complications, such as loss of reduction, especially for non-large-sized or comminuted fractures 15 . Despite suture bridge fixation being used in the treatment of large displaced greater tuberosity fractures 16 , arthroscopic suture bridge repair, such as double row suture anchor repair, is generally used for small-sized fractures of the greater tuberosity [17][18][19] . This may be largely due to insufficient mechanical stability of suture bridge fixation for non-small-sized or comminuted fractures of the greater tuberosity 19 .…”