Isolated greater tuberosity fractures of the proximal humerus: anatomy, injury patterns, multimodality imaging, and approach to management

White, Eric A.; Skalski, Matt; Patel, Dakshesh B.; Gross, Jordan S.; Tomasian, Anderanik; Heckmann, Nathanael; Matcuk, George R.

doi:10.1007/s10140-018-1589-8

Cited by 29 publications

(18 citation statements)

References 46 publications

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“…Arthroscopy enables (1) reduction of the posterosuperiorly displaced fracture fragment less invasively, (2) the evaluation and simultaneous treatment of other lesions like labral and rotator cuff injuries, and (3) reduction of the radiation hazard. There are some reports of concomitant rotator cuff injuries or capsulolabral injuries with isolated greater tuberosity fractures 12, 13. Recent arthroscopic techniques have allowed us to reduce and fix this fracture by arthroscopy and have shown satisfactory early clinical results in several studies 5, 6.…”

Section: Discussionmentioning

confidence: 99%

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

Kim

Noh

Lee

2019

Arthroscopy Techniques

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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.

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Section: Discussionmentioning

confidence: 99%

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

Kim

Noh

Lee

2019

Arthroscopy Techniques

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“…Immediately after surgery and for the first 4 postoperative weeks a shoulder sling with 15 to 20 of arm [2]) and anteriorly into the torn tendon [3]. In the circle: the arthroscopic view showing the suture distribution as depicted in the figure.…”

Section: Rehabilitationmentioning

confidence: 99%

“…(A) Superior displaced fracture avulsion of the greater tuberosity. (B) Once the augmentation is implanted on the lateral cortex of the humerus the sutures, coming out from the transosseous exit point into the crater fracture, are passed posteriorly into the tendon of the avulsed fragment ([1] and[2]) and anteriorly into the torn tendon[3]. In the circle: the arthroscopic view showing the suture distribution as depicted in the figure.…”

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confidence: 99%

Fracture Avulsion of the Greater Tuberosity: Arthroscopic Transosseous Augmented Technique

Chillemi

Proietti

Rengo

et al. 2021

Arthroscopy Techniques

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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.

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“…Treatment for the fracture of humeral great tubercle can be classi ed into conservative and surgical types. At present, most of greater tuberosity fractures can be treated by conservative management, but some of them still have poor prognosis, which is due to full-thickness rotator cuff tears associated with the tubercule fracture [3,4], often resulting in shoulder joint pain, movement limitation, acromion impingement, limb weakness and other functional disorders [5]. Although the surgical indication for fractures of the humeral greater tubercle is still controversial, most surgeons suggest that if the fracture displacement is more than 5 mm, surgical treatment will be recommended [6].…”

Section: Introductionmentioning

confidence: 99%

Minimally invasive open reduction by a modified suture bridge with anchors for avulsion-type greater tuberosity fracture of the humerus

Kong

Yang

et al. 2021

Preprint

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Background: This study aims to describe a modified surgical method of minimally invasive open reduction by a modified suture bridge with anchors for avulsion-type greater tuberosity fracture of the humerus and to evaluate its clinical effectiveness.Methods: From January 2015 to January 2018, 16 patients who were diagnosed with an avulsion-type greater tuberosity fracture of the proximal humerus and treated with minimally invasive open reduction by modified suture bridges with anchors were retrospectively studied. All patients were followed up with clinical examination and radiographs at 3 weeks, 6 weeks, 3 months, 6 months and 12 months after surgery and then every 6 months. Outcomes were assessed preoperatively and postoperatively with the visual analog scale (VAS), the University of California Los Angeles (UCLA) shoulders score, the American Shoulder and Elbow Surgeons score (ASES), and the range of motion (ROM) for shoulders.Results: There were 7 males and 9 females with an average age of 44.94 years. Six fractures involved the left shoulder, and 10 involved the right shoulder. The time between injury and operation ranged from 1 to 5 days, with an average of 2.32 days. The average length of stay was 6.5 ± 0.85 days; the mean operation time was 103.1 ± 7.23 minutes; and the mean amount of operative blood loss was 51.88 ± 6.40 ml. All patients achieved bone union within 3 months after surgery. The VAS score significantly decreased at 3 weeks postoperatively (p = 0.002), as did the average degree of forward elevation (p = 0.047). The mean degree of abduction increased at 6 weeks after the operation (p = 0.035), and the average degree of external rotation and internal rotation improved at 3 months postoperatively (p = 0.012; p = 0.007). The ASES score and the UCLA score improved at the 6-week follow-up (p = 0.092; p = 0.029). No procedure-related death or incision-related superficial or deep tissue infection was identified in any case. No iatrogenic neurovascular injuries or fractures were found in this study.Conclusion: The fracture block was fixed firmly by minimally invasive open reduction with a modified suture bridge with anchors. Patients were allowed to move their shoulder early after surgery and recovered quickly. It is an efficient method for the treatment of avulsion-type greater tuberosity fractures of the humerus.

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Isolated greater tuberosity fractures of the proximal humerus: anatomy, injury patterns, multimodality imaging, and approach to management

Cited by 29 publications

References 46 publications

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

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

Fracture Avulsion of the Greater Tuberosity: Arthroscopic Transosseous Augmented Technique

Minimally invasive open reduction by a modified suture bridge with anchors for avulsion-type greater tuberosity fracture of the humerus

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