Transosseous Suture Fixation of Proximal Humeral Fractures

Dimakopoulos, P.; Panagopoulos, Andreas; Kasimatis, Georgios

doi:10.2106/jbjs.h.01290

Cited by 35 publications

(26 citation statements)

References 5 publications

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“…Three-part fractures may be fixed with open reduction and plate fixation, tension band wiring (mostly abandoned), closed reduction, and percutaneous pinning with terminally threaded wire fixation 261 or intramedullary fixation with suture augmentation of the tuberosity fragment. Attention must be given to accurate reduction in the tuberosities and fixation sufficient to maintain fracture reduction to allow for the tuberosity fracture healing required for acceptable postoperative function.…”

Section: Surgical Treatmentmentioning

confidence: 99%

A Guide to Improving the Care of Patients with Fragility Fractures, Edition 2

Mears¹,

Kates²

2015

Geriatr Orthop Surg Rehabil

132

121

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Over the past 4 decades, much has been learned about the pathophysiology and treatment of osteoporosis, the prevention of fragility fractures, and the perioperative management of patients who have these debilitating injuries. However, the volume of published literature on this topic is staggering and far too voluminous for any clinician to review and synthesize by him or herself. This manuscript thoroughly summarizes the latest research on fragility fractures and provides the reader with valuable strategies to optimize the prevention and management of these devastating injuries. The information contained in this article will prove invaluable to any health care provider or health system administrator who is involved in the prevention and management of fragility hip fractures. As providers begin to gain a better understanding of the principles espoused in this article, it is our hope that they will be able to use this information to optimize the care they provide for elderly patients who are at risk of or who have osteoporotic fractures.

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Section: Surgical Treatmentmentioning

confidence: 99%

A Guide to Improving the Care of Patients with Fragility Fractures, Edition 2

Mears¹,

Kates²

2015

Geriatr Orthop Surg Rehabil

132

121

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“…87 Attention must be given to accurate reduction of the greater and lesser tuberosities with sutures or wires to allow for acceptable postoperative function. Attention must also be paid to restoration of medial bony contact to prevent varus collapse and screw penetration into the joint.…”

Section: Nonhip Fractures Proximal Humerus Fractures (H Hoyen and Smentioning

confidence: 99%

A Guide to Improving the Care of Patients With Fragility Fractures

Bukata

DiGiovanni

Friedman

et al. 2011

Geriatr Orthop Surg Rehabil

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ForewordFragility fractures, low-energy injuries that occur from a fall from a standing or lower height, represent a serious public health problem. After age 50, the lifetime risk of having a fragility fracture is 33% for an American woman and 20% for a man. 1 In the United States, 2.1 million people will suffer a fragility fracture each year.1 The incidence of fragility fractures increases steeply after age 65.2 Osteoporosis is present in most patients with a fragility fracture.Hip fractures are the most serious in terms of cost and morbidity. The average cost of inpatient care for a hip fracture in 2005 was $33 962.3 The lifetime risk of having a hip fracture is 6% for men and 17.5% for women. Although the mortality risk after a hip fracture is much higher for a man, a woman's risk of dying from a hip fracture is high and exceeds the lifetime risk of death from breast cancer, uterine cancer, and ovarian cancer combined. For those who survive after a hip fracture, most do not regain their preinjury level of function, and 30% lose their independence. This loss of independence is greatly feared by patients and is very costly to patients and society.Although a hip fracture may have the most serious consequences, other bones, such as the wrist, shoulder, ankle, pelvis, and spine, frequently fracture in the osteoporotic patient. For example, the lifetime risk of a forearm or vertebral compression fracture is 16% and 15.6%, respectively, for a woman and 2.5% and 5%, respectively, for a man. 4 These statistics clearly show that fragility fractures are a major problem facing American society today, 5 and the care of such fractures presents an even greater challenge, in part because the quality of care delivered in the United States varies widely, even within one region. Many such fractures are treated in an outpatient setting, although some may be treated in the inpatient hospital setting. However, the quality of care for seniors with fragility fractures receives relatively little attention. In 2004, the United States Surgeon General issued a comprehensive report calling for health professionals to make significant improvements in our nation's bone health, and an improvement in the system and methods of care was suggested. 5There has been little written on the subject of improving the system of care delivery in the United States.The goals of this blue book are to review the methods used in inpatient and outpatient care, as well as rehabilitation of the patient with a fragility fracture. We discuss evidence-based best care models and, where evidence is lacking, present expert opinions in an effort to improve the standard and the quality of care for the patient with a fragility fracture. We hope that this monograph will provide guidance to physicians, nurses, rehabilitation therapists, other health care providers, and administrators.Stephen L. Kates, MD Editor-in-Chief Simon C. Mears, MD, PhD

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“…Even a small amount of displacement can affect shoulder function [11,30]. Several fixation techniques using screw, tension banding, or transosseous suture have been described for reduction and internal fixation of greater tuberosity fractures [7,9,15]. Despite the reported satisfactory results [8,9,15], few techniques can provide adequate fixation of the fragments and accurate restoration of the tuberosity-head relation for comminuted fractures [3].…”

Section: Introductionmentioning

confidence: 99%

Is Arthroscopic Technique Superior to Open Reduction Internal Fixation in the Treatment of Isolated Displaced Greater Tuberosity Fractures?

Liao¹,

Zhang²,

Li³

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Arthroscopic double-row suture-anchor fixation and open reduction and internal fixation (ORIF) are used to treat displaced greater tuberosity fractures, but there are few data that can help guide the surgeon in choosing between these approaches. Questions/Purposes We therefore asked: (1) Is there a difference in surgical time between arthroscopic doublerow suture anchor fixation and ORIF for isolated displaced greater tuberosity fractures? (2) Are there differences in the postoperative ROM and functional scores between arthroscopic double-row suture anchor fixation and ORIF for isolated displaced greater tuberosity fractures? (3) Are there differences in complications resulting in additional operations between the two approaches?Methods Between 2006 and 2012, we treated 79 patients surgically for displaced greater tuberosity fractures. Of those, 32 (41%) were considered eligible for our study based on inclusion criteria for isolated displaced greater tuberosity fractures with a displacement of at least 5 mm but less than 2 cm. During that time, we generally treated patients with displaced greater tuberosity fractures with a displacement greater than 1 cm or with a fragment size greater than 393 cm with open treatment, and patients with displaced greater tuberosity fractures with a displacement less than 1 cm or with a fragment size less than 393 cm with arthroscopic treatment. Fifty-three underwent open treatment based on those indications, and 26 underwent arthroscopic treatment, of whom 17 (32%) and 15 (58%) were available for followup at a mean of 34 months (range, 24-28 months). All patients with such fractures identified from our institutional database were treated by these two approaches and no other methods were used. Surgical time was defined as the time from initiation of the incision to the time when suture of the incision was finished, and was determined by an observer with a stopwatch. Patients were followed up in the outpatient department at 6, 12, and 24 weeks, and every 6 month thereafter. Radiographs showed optimal reduction immediately after surgery and at every followup. Radiographs were obtained to assess fracture healing. Patients were followed up for a mean of 34 months (range, 24-48 months). At the last followup, ROM, VAS score, and American Shoulder and Elbow Surgeons (ASES) score were used to evaluate clinical outcomes. All these data were retrieved from our institutional database through chart review. Complications were assessed through chart review by one observer other than the operating surgeon.

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Transosseous Suture Fixation of Proximal Humeral Fractures

Cited by 35 publications

References 5 publications

A Guide to Improving the Care of Patients with Fragility Fractures, Edition 2

A Guide to Improving the Care of Patients with Fragility Fractures, Edition 2

A Guide to Improving the Care of Patients With Fragility Fractures

Is Arthroscopic Technique Superior to Open Reduction Internal Fixation in the Treatment of Isolated Displaced Greater Tuberosity Fractures?

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