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Arthroscopic reduction and fixation for displaced greater tuberosity fractures using the modified suture-bridge technique

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Abstract

Purpose

The aim of this study was to evaluate the early clinical outcomes of arthroscopic treatment of avulsion or comminuted fractures of the greater tuberosity (GT) using a modified suture-bridge technique.

Methods

Between February 2013 and November 2015, 14 patients with displaced or comminuted fractures of GT were arthroscopically treated using a modified suturebridge technique. Displacement of the GT fragments was > 3 mm in any plane. An analysis of follow-up results including the University of California, Los Angeles (UCLA) shoulder scale; the shoulder index of the American Shoulder and Elbow Surgeons (ASES); the simple shoulder test (SST); and shoulder range of motion (ROM), is presented.

Results

Mean duration of follow up is 18.9 months (range, 6–30). Mean age of patients was 62.9 years (range, 49–74). Postoperatively, the outcomes were rated as excellent, good and fair in two, 11 and one patient, respectively based on the UCLA score. At the most recent follow-up, the average UCLA score increased to 32 points, the ASES score increased to 97.5 points, and the SST score increased to 11 points. Average forward flexion was 153.6°, average abduction was 158.6°, average external rotation in the neutral position was 38.6°, and internal rotation increased to the 12th thoracic vertebral level.

Conclusion

Early follow-up outcomes of the arthroscopic modified suture-bridge technique used for avulsion or comminuted GT fractures are promising. The technique can be used as one of the therapeutic modalities for GT fractures.

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References

  1. Court-Brown CM, Garg A, McQueen MM (2001) The epidemiology of proximal humeral fractures. Acta Orthop Scand 72(4):365–371. doi:10.1080/000164701753542023

    Article  CAS  PubMed  Google Scholar 

  2. Gruson KI, Ruchelsman DE, Tejwani NC (2008) Isolated tuberosity fractures of the proximal humeral: current concepts. Injury 39(3):284–298. doi:10.1016/j.injury.2007.09.022

    Article  PubMed  Google Scholar 

  3. Neer C (1970) Displaced proximal humeral fractures. I. Classification and evaluation. J Bone Joint Surg Am 52(6):1077–1089

    Article  PubMed  Google Scholar 

  4. Bigliani LU, Flatow EL, Pollock RG (1998) Fractures of the proximal humerus. In: Rockwood CA, MatBen FA, (eds) The shoulder. WB Saunders, Philadelphia, pp 337-389

  5. Park MC, Murthi AM, Roth NS, Blaine TA, Levine WN, Bigliani LU (2003) Two-part and three-part fractures of the proximal humerus treated with suture fixation. J Orthop Trauma 17(5):319–325

    Article  PubMed  Google Scholar 

  6. Dimakopoulos P, Panagopoulos A, Kasimatis G (2007) Transosseous suture fixation of proximal humeral fractures. J Bone Joint Surg Am 89(8):1700–1709. doi:10.2106/JBJS.F.00765

    PubMed  Google Scholar 

  7. Flatow EL, Cuomo F, Maday MG, Miller SR, McIlveen SJ, Bigliani LU (1991) Open reduction and internal fixation of two-part displaced fractures of the greater tuberosity of the proximal part of the humerus. J Bone Joint Surg Am 73(8):1213–1218

    Article  CAS  PubMed  Google Scholar 

  8. Herscovici D Jr, Saunders DT, Johnson MP, Sanders R, DiPasquale T (2000) Percutaneous fixation of proximal humeral fractures. Clin Orthop Relat Res 375:97–104

    Article  Google Scholar 

  9. Dimakopoulos P, Panagopoulos A, Kasimatis G, Syggelos SA, Lambiris E (2007) Anterior traumatic shoulder dislocation associated with displaced greater tuberosity fracture: the necessity of operative treatment. J Orthop Trauma 21(2):104–112. doi:10.1097/BOT.0b013e3180316cda

    Article  PubMed  Google Scholar 

  10. Park S-E, Jeong J-J, Panchal K, Lee J-Y, Min H-K, Ji J-H (2016) Arthroscopic-assisted plate fixation for displaced large-sized comminuted greater tuberosity fractures of proximal humerus: a novel surgical technique. Knee Surg Sports Traumatol Arthrosc 24(12):3892–3898

  11. Ellman H, Hanker G, Bayer M (1986) Repair of the rotator cuff. End-result study of factors influencing reconstruction. J Bone Joint Surg Am 68(8):1136–1144

    Article  CAS  PubMed  Google Scholar 

  12. Roddey TS, Olson SL, Cook KF, Gartsman GM, Hanten W (2000) Comparison of the University of California-Los Angeles shoulder scale and the simple shoulder test with the shoulder pain and disability index: single-administration reliability and validity. Phys Ther 80(8):759–768

    CAS  PubMed  Google Scholar 

  13. Coghlan JA, Bell SN, Forbes A, Buchbinder R (2008) Comparison of self-administered University of California, Los Angeles, shoulder score with traditional University of California, Los Angeles, shoulder score completed by clinicians in assessing the outcome of rotator cuff surgery. J Shoulder Elbow Surg Am 17(4):564–569

    Article  Google Scholar 

  14. Wylie JD, Beckmann JT, Granger E, Tashjian RZ (2014) Functional outcomes assessment in shoulder surgery. World J Orthop 5(5):623–633. doi:10.5312/wjo.v5.i5.623

    Article  PubMed  PubMed Central  Google Scholar 

  15. Michener LA, McClure PW, Sennett BJ (2002) American shoulder and elbow surgeons standardized shoulder assessment form, patient self-report section: reliability, validity, and responsiveness. J Shoulder Elbow Surg Am 11(6):587–594. doi:10.1067/mse.2002.127096

    Article  Google Scholar 

  16. Beaton D, Richards RR (1998) Assessing the reliability and responsiveness of 5 shoulder questionnaires. J Shoulder Elbow Surg Am 7(6):565–572

    Article  CAS  Google Scholar 

  17. Kocher MS, Horan MP, Briggs KK, Richardson TR, O’Holleran J, Hawkins RJ (2005) Reliability, validity, and responsiveness of the American shoulder and elbow surgeons subjective shoulder scale in patients with shoulder instability, rotator cuff disease, and glenohumeral arthritis. J Bone Joint Surg Am 87(9):2006–2011. doi:10.2106/jbjs.c.01624

    PubMed  Google Scholar 

  18. Skutek M, Fremerey RW, Zeichen J, Bosch U (2000) Outcome analysis following open rotator cuff repair. Early effectiveness validated using four different shoulder assessment scales. Arch Orthop Trauma Surg 120(7–8):432–436

    Article  CAS  PubMed  Google Scholar 

  19. Beaton DE, Richards RR (1996) Measuring function of the shoulder. A cross-sectional comparison of five questionnaires. J Bone Joint Surg Am 78(6):882–890

    Article  CAS  PubMed  Google Scholar 

  20. Kirkley A, Griffin S, Dainty K (2003) Scoring systems for the functional assessment of the shoulder. Arthroscopy 19(10):1109–1120. doi:10.1016/j.arthro.2003.10.030

    Article  PubMed  Google Scholar 

  21. Lippitt S, Harryman D, Matsen F, Fu F, Hawkins R (1993) A practical tool for evaluating function: the simple shoulder test. The shoulder: a balance of mobility and stability. American Academy of Orthopaedic Surgeons, Rosemont, IL, pp 501–518

  22. Ellman H (1987) Arthroscopic subacromial decompression: analysis of one- to three-year results. Arthroscopy 3(3):173–181

    Article  CAS  PubMed  Google Scholar 

  23. Green A, Izzi J (2003) Isolated fractures of the greater tuberosity of the proximal humerus. J Shoulder Elb Surg 12(6):641–649. doi:10.1016/s1058-2746(02)86811-2

    Article  Google Scholar 

  24. Müller M, Nazarian S, Koch P, Schatzker J (1990) The comprehensive classification of fractures of long bones. Springer Berlin, Heidelberg, pp 128–137

    Book  Google Scholar 

  25. Rouleau DM, Mutch J, Laflamme GY (2016) Surgical treatment of displaced greater tuberosity fractures of the humerus. J Am Acad Orthop Surg 24(1):46–56. doi:10.5435/jaaos-d-14-00289

    Article  PubMed  Google Scholar 

  26. Mutch J, Laflamme GY, Hagemeister N, Cikes A, Rouleau DM (2014) A new morphological classification for greater tuberosity fractures of the proximal humerus: validation and clinical implications. Bone Joint J 96-B(5):646–651. doi:10.1302/0301-620X.96B5.32362

    Article  CAS  PubMed  Google Scholar 

  27. Ogawa K, Yoshida A, Ikegami H (2003) Isolated fractures of the greater tuberosity of the humerus: solutions to recognizing a frequently overlooked fracture. J Trauma 54(4):713–717. doi:10.1097/01.TA.0000057230.30979.49

    Article  PubMed  Google Scholar 

  28. McLaughlin HL (1963) Dislocation of the shoulder with tuberosity fracture. Surg Clin North Am 43:1615–1620

    Article  CAS  PubMed  Google Scholar 

  29. Bono CM, Renard R, Levine RG, Levy AS (2001) Effect of displacement of fractures of the greater tuberosity on the mechanics of the shoulder. J Bone Joint Surg Br 83(7):1056–62

  30. Platzer P, Kutscha-Lissberg F, Lehr S, Vecsei V, Gaebler C (2005) The influence of displacement on shoulder function in patients with minimally displaced fractures of the greater tuberosity. Injury 36(10):1185–1189. doi:10.1016/j.injury.2005.02.018

    Article  PubMed  Google Scholar 

  31. DeBottis D, Anavian J, Green A (2014) Surgical management of isolated greater tuberosity fractures of the proximal humerus. Orthop Clin N Am 45(2):207–218. doi:10.1016/j.ocl.2013.12.007

    Article  Google Scholar 

  32. Porcellini G, Campi F, Paladini P (2002) Articular impingement in malunited fracture of the humeral head. Arthroscopy 18(8):E39

    Article  PubMed  Google Scholar 

  33. Bhatia DN, van Rooyen KS, du Toit DF, de Beer JF (2006) Surgical treatment of comminuted, displaced fractures of the greater tuberosity of the proximal humerus: a new technique of double-row suture-anchor fixation and long-term results. Injury 37(10):946–952. doi:10.1016/j.injury.2006.06.009

    Article  PubMed  Google Scholar 

  34. Ji JH, Kim WY, Ra KH (2007) Arthroscopic double-row suture anchor fixation of minimally displaced greater tuberosity fractures. Arthroscopy 23(10):1133.e1-4. doi:10.1016/j.arthro.2006.11.029

    Article  PubMed  Google Scholar 

  35. Ji JH, Shafi M, Song IS, Kim YY, McFarland EG, Moon CY (2010) Arthroscopic fixation technique for comminuted, displaced greater tuberosity fracture. Arthroscopy 26(5):600–609. doi:10.1016/j.arthro.2009.09.011

    Article  PubMed  Google Scholar 

  36. Cadet ER, Ahmad CS (2007) Arthroscopic reduction and suture anchor fixation for a displaced greater tuberosity fracture: a case report. J Shoulder Elbow Surg Am 16(4):e6–e9. doi:10.1016/j.jse.2006.08.010

    Article  Google Scholar 

  37. Kim KC, Rhee KJ, Shin HD, Kim YM (2008) Arthroscopic fixation for displaced greater tuberosity fracture using the suture-bridge technique. Arthroscopy 24(1):120.e1-3. doi:10.1016/j.arthro.2007.05.003

    Article  PubMed  Google Scholar 

  38. Song HS, Williams GR Jr (2008) Arthroscopic reduction and fixation with suture-bridge technique for displaced or comminuted greater tuberosity fractures. Arthroscopy 24(8):956–960. doi:10.1016/j.arthro.2008.01.009

    Article  PubMed  Google Scholar 

  39. McLaughlin-Symon I, Kenyon P, Morgan B, Ravenscroft M (2015) A new “trapdoor technique” for fixation of displaced greater tuberosity fractures of the shoulder. J Hand Microsurg 7(2):241–243. doi:10.1007/s12593-015-0190-6

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedics, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, No. 301, Yanchang Road, Shanghai, 200072, China

    RenLong Li, Ming Cai & Kun Tao

  2. Medical Department, Soochow University, Suzhou, Jiangsu, 215123, China

    RenLong Li

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  1. RenLong Li
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  2. Ming Cai
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  3. Kun Tao
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Correspondence to Ming Cai or Kun Tao.

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Li, R., Cai, M. & Tao, K. Arthroscopic reduction and fixation for displaced greater tuberosity fractures using the modified suture-bridge technique. International Orthopaedics (SICOT) 41, 1257–1263 (2017). https://doi.org/10.1007/s00264-017-3461-y

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