Proximal Humerus Shaft Fracture After Pectoralis Major Tendon Rupture Repair

Abstract

Surgical repair of a complete pectoralis major tendon rupture at the humeral insertion has superior results compared to nonoperative treatment. To our knowledge, a proximal humerus shaft fracture occurring at the site of the bone trough and cortical drill holes after a pectoralis major tendon rupture repair has not been reported in the literature.A 45-year-old man sustained an acute left pectoralis major tendon rupture at the humeral insertion while performing a bench press maneuver. He underwent acute surgical repair. Approximately 8 weeks postoperatively, the patient fell from a standing height and sustained a proximal humerus shaft fracture through the repair site at the bone trough. Three days after the fracture, the patient underwent open reduction and internal fixation of the proximal humerus shaft fracture and exploration of the pectoralis major tendon repair. The fracture was found to be at the level of the repair site, and the pectoralis major tendon was completely intact to the distal fragment. The fracture healed uneventfully, and the patient regained full motion and strength of his extremity with no limitations.Any type of surgical fixation that creates a hole in the humerus or decreases the cross-sectional area such as a bone trough creates a stress riser. Patients undergoing pectoralis tendon repair that involves violating the humerus with a bone trough or hole have a slight risk of postoperative humerus fracture, especially if sustaining an early traumatic event such as a fall.

A case report of periprosthetic fracture left proximal humerus with radial nerve palsy following pectoralis major repair

“…Eight weeks prior to the injury a PM tendon repair had been completed through the creation of suture tunnels through a bone trough to provide a hold for a modified Kessler suture. In this case the perioperative findings demonstrated that the new fracture was through the bone trough, with the PM tendon repair intact .…”

“…As described in the introduction, there is one previously published case of proximal shaft of humerus fracture following PM tendon repair . This has significant difference from the case described as the management of the initial injury did not include the use of suture anchors and the proximal humeral fracture was fixed with a locking plate.…”

Pectoralis Major Repair With Unicortical Button Fixation And Suture Tape

“…In that study, one of the bone trough repairs failed because of a proximal humerus fracture, which has also been described in the clinical literature. 20 Given the limited number of controlled trials and studies that have assessed these various repair techniques for pectoralis major rupture, it is difficult to objectively discern the best fixation technique, as all have had some level of success.…”

Pectoralis Major Repair With Cortical Button Technique

“…17 It also takes more time to perform this fixation method than the cortical button method. Another advantage of the cortical button method is that it allows the surgeon to pull the tendon to the footprint, rather than pushing it to the footprint.…”