Surgical Management of Isolated Greater Tuberosity Fractures of the Proximal Humerus

DeBottis, Daniel; Anavian, Jack; Green, Andrew

doi:10.1016/j.ocl.2013.12.007

Cited by 29 publications

(36 citation statements)

References 35 publications

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“…The displacement directions of the GT fragments are dependent on the directions of the force vector of the three rotator cuff tendons. The force of the supraspinatus tendon displaces the fragment anterosuperiorly, while the force of the infraspinatus tendon causes the fragment to displace posteroinferiorly 30 .…”

Section: Discussionmentioning

confidence: 99%

Injury Mechanism of Acute Anterior Shoulder Dislocation Associated with Glenoid and Greater Tuberosity Fractures: A Study Based on Fracture Morphology

Dai

Xiang

Yang

et al. 2020

Orthopaedic Surgery

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Based on the morphological characteristics of glenoid and greater tuberosity (GT) fractures and the relationship between them, we explored the injury mechanism of acute anterior shoulder dislocation associated with glenoid and GT fractures. Methods: From December 2013 to December 2019, we retrospectively reviewed the clinical data of patients who were diagnosed with acute anterior shoulder dislocation associated with glenoid and GT fractures in our hospital. According to the fracture site, a glenoid fracture group and a greater tuberosity fracture (GT) group were established, and the morphological characteristics of both glenoid and GT fractures were measured and statistically analyzed. Results: A total of 41 patients (43 shoulders) met the inclusion criteria (39 unilateral shoulders and 2 bilateral shoulders). The mean age was 50.21 years (range, 22-71 years). A total of 27 shoulder injuries (62.8%) were split GT fractures and 33 shoulder injuries (76.7%) were combined with rotator cuff tears. The mean size of glenoid fragments was 30.16% and the mean displacement was 8.85 mm. The mean size of GT fragments was 28.43 mm. The mean superoinferior and anteroposterior displacements of the GT fragment were 6.77 mm and 4.96 mm, respectively. There was a negative correlation between the size of glenoid and GT fracture fragments (r = −0.64, P < 0.05). The glenoid fragments in the Ideberg type Ia glenoid fracture group were smaller than those in the Ideberg type II glenoid fracture group (28.41% and 40.95%, respectively), while the size of GT fragments in the type Ia group were larger than those in the type II group (29.77 mm and 20.21 mm, respectively) (P < 0.05). The GT fragments in the split GT fracture group were larger than those in the avulsion or depression GT fracture group (33.69 mm, 19.07 mm and 21.12 mm, respectively), while the size of glenoid fragments in the split GT fracture group were smaller than those in the avulsion or depression GT fracture group (23.57%, 41.37%, and 43.42%, respectively) (P < 0.05). As for the displacement direction of GT fragments, depression fractures were mainly inferior displacements, avulsion fractures were mainly anterosuperior displacements, while split fractures were mainly posteroinferior displacements (P < 0.05). Multiple regression analysis suggested that the type and the fragment size of GT fractures have a significant influence on the size of glenoid fragments. Conclusion: Acute anterior shoulder dislocations associated with glenoid and GT fractures are often combined with rotator cuff tears. There is a negative correlation between the size of glenoid and GT fragments, and split GT fractures are most common. Such injuries are highly correlated to the relative spatial location between the GT and the glenoid when the shoulder dislocates.

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Section: Discussionmentioning

confidence: 99%

Injury Mechanism of Acute Anterior Shoulder Dislocation Associated with Glenoid and Greater Tuberosity Fractures: A Study Based on Fracture Morphology

Dai

Xiang

Yang

et al. 2020

Orthopaedic Surgery

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“…When fractured, the greater tuberosity often displaces posteriorly and superiorly due to the deforming forces of the rotator cuff muscles. If its displacement is more than 5 mm, it can affect overhead elevation of the arm and cause subacromial impingement, and may block external rotation with the arm at the side [29, 30]. Arthroscopic and open fixation techniques can be used to surgically treat GT fracture with good patient outcomes [30, 31].…”

Section: Discussionmentioning

confidence: 99%

“…If its displacement is more than 5 mm, it can affect overhead elevation of the arm and cause subacromial impingement, and may block external rotation with the arm at the side [29, 30]. Arthroscopic and open fixation techniques can be used to surgically treat GT fracture with good patient outcomes [30, 31]. Moreover, our results will aid evidence-based medicine in decision-making for treating this unique fracture, particularly when surgical intervention with suture anchor-based fixation is considered.…”

Section: Discussionmentioning

confidence: 99%

Different suture anchor fixation techniques affect contact properties in humeral greater tuberosity fracture: a biomechanical study

Lin

Yeh

et al. 2019

BMC Musculoskelet Disord

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BackgroundSuture anchor-based fixations of humeral greater tuberosity (GT) fractures have yielded good outcomes in both clinical and biomechanical studies. Be that as it may, the interface contact properties of these fixations have yet to be elaborated. In response, the contact characteristics of two double-row suture anchor fixations for the management of GT fracture were compared.MethodsTwo suture anchor-based fixation techniques, namely the Double-Row Suture Anchor Fixation (DR) and Suture-Bridge Technique (SB), were used to repair humeral GT fractures in 12 fresh-frozen human cadaveric shoulders. A Tekscan pressure sensor placed between the repaired tuberosity and humerus recorded continuous data points directly after repair and for 60 min at set time intervals. The constructs were then cyclically loaded until 100 N, and the shoulders tested at 0°, 30°, and 60° of abduction. Under an applied force, the contact pressure and contact area of the interface were determined.ResultsAlthough both fixation configurations showed decreased contact pressure and area over time, the SB group had higher contact pressure right after fixation and at all time points thereafter. In contrast, the DR group demonstrated significantly more contact pressure and area at each abduction position with the applied load. Nevertheless, contact pressure and area decreased in response to increasing abduction position for both fixation constructs.ConclusionFindings suggest that despite the SB construct having superior interface contact immediately after fixation, the DR construct offered better contact performance at all abduction angles with applied force.Level of evidenceBasic Science, Biomechanics.

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“…Accordingly, a greater tuberosity fracture can have significant functional consequences and therefore must not be trivialised or overlooked. 12 Typically, non-operative treatment is advocated for greater tuberosity fractures with <5–10 mm displacement. Our patient was reviewed at 6 weeks, 6 months and 1 year following injury, clinically and radiologically and demonstrated anatomical bony union and unrestricted functional outcome with non-operative management in an abduction brace.…”

Section: Discussionmentioning

confidence: 99%

Chloroquine-induced bilateral anterior shoulder dislocation: a unique aetiology for a rare clinical problem

Martin¹,

Tsekes

White

et al. 2016

BMJ Case Reports

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Bilateral anterior shoulder dislocation is a rare clinical entity with few case reports and limited series published in the literature. Bilateral shoulder dislocations are rare and of them, most are posterior. We present a highly unusual case of bilateral, atraumatic, anterior shoulder dislocation with concomitant comminuted greater tuberosity fracture on the right side, secondary to seizure, in a patient without known epilepsy, induced by oral chloroquine medication. We demonstrate the treatment approach that led to a satisfactory clinical outcome, evidenced by radiological union, clinical assessment and Patient Reported Outcome Measure data, following non-operative management of both shoulders. The unusual mechanism for anterior shoulder dislocation, the asymmetric dislocation pattern and peculiar precipitant for the causative seizure all provide interesting learning points from this case.

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Surgical Management of Isolated Greater Tuberosity Fractures of the Proximal Humerus

Cited by 29 publications

References 35 publications

Injury Mechanism of Acute Anterior Shoulder Dislocation Associated with Glenoid and Greater Tuberosity Fractures: A Study Based on Fracture Morphology

Injury Mechanism of Acute Anterior Shoulder Dislocation Associated with Glenoid and Greater Tuberosity Fractures: A Study Based on Fracture Morphology

Different suture anchor fixation techniques affect contact properties in humeral greater tuberosity fracture: a biomechanical study

Chloroquine-induced bilateral anterior shoulder dislocation: a unique aetiology for a rare clinical problem

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