Biomechanical Contribution of Tension-Reducing Rotator Cuff Sutures in 3-Part Proximal Humerus Fractures

Arvesen, John; Gill, Stephen W.; Sinatra, Philip M.; Eng, Michael; Bledsoe, Gary; Kaar, Scott G.

doi:10.1097/bot.0000000000000575

Cited by 20 publications

(17 citation statements)

References 19 publications

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“…We have learned important predictors of success include restoration or maintenance of the medial calcar [43], avoiding varus alignment [44], and less aggressive proximal screw fixation [45]. Although not biomechanically shown to be beneficial, rotator cuff sutures have become the standard among fracture surgeons for fragment mobilization, provisional reduction, and final construct incorporation [46]. More recent analyses of proximal humerus fractures treated with newer locking plates show less complications and improved outcomes.…”

Section: Orif With Locked Platesmentioning

confidence: 99%

Reverse Shoulder Arthroplasty for Proximal Humerus Fracture

Kelly

Myeroff

2020

Curr Rev Musculoskelet Med

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Purpose of Review The purpose of this review is to examine trends, outcomes, and principles in treatment of proximal humerus fractures in the elderly with a critical focus on reverse shoulder arthroplasty as a developing treatment option. Recent Findings Recent literature shows an increase in reverse shoulder arthroplasty and a decrease in hemiarthroplasty performed for proximal humerus fractures. More predictable outcomes and lower revision rates are seen in older individuals treated primarily or secondarily with reverse shoulder arthroplasty compared to those treated with hemiarthroplasty. Summary We report current and historical treatments, outcomes, and principles in reverse shoulder arthroplasty for treatment of complex, displaced proximal humerus fractures in older individuals (≥ 65 years old).

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Section: Orif With Locked Platesmentioning

confidence: 99%

Reverse Shoulder Arthroplasty for Proximal Humerus Fracture

Kelly

Myeroff

2020

Curr Rev Musculoskelet Med

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“…Arvesen et al performed a cadaveric study and concluded that tension-relieving rotator cuff sutures with no. 5 FiberWire do not add stability to the repair of 3-part proximal humeral fractures [25]. Furthermore, Voigt et al also reported no contribution to reduce interfragmentary motion by additive fiber-cerclages in unstable 3-part fracture model with an intact rotator cuff [26].…”

Section: Discussionmentioning

confidence: 99%

In vitro evaluation of the tension band suture method for proximal humerus fracture treatment

et al. 2020

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Background Proximal humeral fractures are common, and more than half occur in patients over 65 years of age. Operative treatment may be recommended for displaced, complicated fractures; however, surgery may lead to displacement of the greater tuberosity or humeral head. Supplemental tension band sutures have been recommended to prevent such a complication. In this study, we investigate the best combination of suture, washer, and threading angle for proximal humeral fractures from a mechanical view. Methods The mechanical durability of 18 combinations of suture materials (Fiberwire, Ethibond, and Surgilon), threading washers (ring washer, disc washer), and threading angles (15 or 45°) were examined via a cyclic loading test. Results The most durable combination in the cyclic loading test consisted of threading the Fiber Wire to the washer ring using only one hole (ring washer-1) at 45°. In contrast, the most vulnerable combination was threading Ethibond to the washer disc at 15°. Breakage of all suture materials occurred at the suture-washer interface, and no failure or loosening of the knots was observed. FiberWire gradually eroded until the loss of equilibrium; whereas the rupture of Ethibond and Surgilon occurred suddenly. Conclusions From a mechanical viewpoint, we demonstrated that applying a supplemental tension band suture using FiberWire with a single-hole ring washer threaded at a wider angle is recommended.

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“…This low sampling rate prevents conclusion with certainty that the long posterior screws decrease the strength of spine and/or lead to fracture at lower loads. However, other biomechanical studies have utilized six specimens per group [13][14][15][16]. Specimen number 13 in the L2 (superior screw "all inside, " posterior screw outside-in) group failed at higher load than specimen numbers 10 and 12, which had both screws with outside-in fixation into the scapular spine.…”

Section: B Amentioning

confidence: 99%

Scapular spine base fracture with long outside-in superior or posterior screws with reverse shoulder arthroplasty

Eroğlu

Hüsemoğlu²,

Başçı

et al. 2021

Clin Shoulder Elbow

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Background: The purpose of the present study was to determine how long superior screws alone or in combination with posterior placement of metaglene screws protruding and penetrating into the scapular spine in reverse total shoulder arthroplasty affect the strength of the scapular spine in a fresh cadaveric scapular model.Methods: Seven fresh cadaver scapulas were allocated to the control group (short posterior and superior screws) and seven scapulas to the study group (spine base fixation with a 4-inch-long superior screw, three with both long superior and long posterior screws).Results: The failure load was lower in the spine fixation group (long screw [869 N] vs. short screw [1,123 N]); however, this difference did not reach statistical significance (p>0.05). All outside-in long superior or superior plus posterior screws failed due to scapular spine base fracture; failures in the short screw group were due to acromion fracture. An additional posterior outside-in screw failed to significantly decrease the failure load of the acromion spine.Conclusions: The present study highlights the significance of preventing a cortical breach or an outside-in configuration when a superior or posterior screw is inserted into the scapular spine base.

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Biomechanical Contribution of Tension-Reducing Rotator Cuff Sutures in 3-Part Proximal Humerus Fractures

Cited by 20 publications

References 19 publications

Reverse Shoulder Arthroplasty for Proximal Humerus Fracture

Reverse Shoulder Arthroplasty for Proximal Humerus Fracture

In vitro evaluation of the tension band suture method for proximal humerus fracture treatment

Scapular spine base fracture with long outside-in superior or posterior screws with reverse shoulder arthroplasty

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