Fracture Avulsion of the Greater Tuberosity: Arthroscopic Transosseous Augmented Technique

Abstract

The fracture avulsion of the greater tuberosity (GT) represents 2% of all humerus fractures, but the true incidence is likely to be higher, being challenging the initial diagnosis on radiograph. The fracture avulsion of the GT could have different treatments: nondisplaced or minimally displaced fractures are treated conservatively, whereas for displaced or comminuted fractures surgical treatment is preferred. The most important finding of this study is the employment of an all-arthroscopic transosseous augmented technique for the treatment of a displaced humeral GT fracture avulsion. This technique shows all the advantages of the transosseous fixation and arthroscopic approach.

Arthroscopic Assisted Versus Open Reduction and Internal Fixation of Greater Tuberosity Fractures of the Proximal Humerus

“…Another technique, the authors prefer, is the arthroscopic reduction and trans osseous augmented suture fixation technique useful in osteoporotic patients [32,33]. A trans osseous tunnel is made, establishing the lateral entry point 2 cm below the lateral fracture margin to prevent cracking of the cortex.…”

“…A trans osseous tunnel is made, establishing the lateral entry point 2 cm below the lateral fracture margin to prevent cracking of the cortex. A lateral cortical augmentation can be used to avoid any peak stress on sound bone below the fracture margin [33]. An implant is then anchored with three different loaded sutures in the front eyelet of this implant.…”

A Mid-Scapular Portal for Arthroscopic-Assisted Fixation of Severe Retraction Greater Tuberosity Avulsion Fracture

“…Although open techniques are preferred for large displacement and severe comminution, the arthroscopic technique can enhance visualization to address concomitant injury and preserve the soft tissue around the surgical site. Many arthroscopic techniques have been shown to be used for non- or minimal displacement of greater tuberosity avulsion fractures, 8 , 9 , 10 , 11 , 12 but there has been no study of chronic cases with severe retraction. This technique, proposed by author A.B., describes an additional portal at mid-scapula to aid in the reduction and fixation of severe retraction of greater tuberosity avulsion fracture.…”