Skip to main content

Advertisement

SpringerLink
Log in

Clinical and radiologic outcomes of arthroscopic suture bridge repair for the greater tuberosity fractures of the proximal humerus

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Purpose

To report the clinical and radiological outcomes of arthroscopic suture bridge repair for the GT fractures of the shoulder joint.

Methods

From March 2008 to July 2013, we performed arthroscopic suture bridge repair of the GT fractures displaced more than 5 mm superiorly or posteriorly, but less than 2 cm in 40 cases [20 men, 20 women; mean age, 56 (27–80) years] with the average 32 (24–48) months follow-up. At the final follow-up, clinical (ASES, UCLA, SST, KSS score and range of motions) and radiological outcomes using post-operative MRI or CT scan were evaluated. Associated injuries occurred in 21 cases (52.5%): 8 rotator cuff tears; 7 SLAP lesions; 3 glenoid rim fractures; 3 Bankart lesions; 5 biceps tendon tears; 1 partial subscapularis tear; 1 combined subscapularis and biceps tendon tear, and 1 brachial plexus injury.

Results

At the final follow-up, the mean VAS score improved from 7 to 1; ASES, to 92; UCLA, to 32; KSS, to 90; and SST, to 10. Mean forward flexion, abduction, external rotation at the side, and internal rotation at the back were improved to 157°, 157°, 37° and T11, respectively. Mean residual superior and posterior displacement of the fracture was 0 (range −5 to 3.3) mm and 0.1 (−5.5 to 3.2) mm, respectively, compared to pre-operative displacement of 4.9 (0–14) mm and 4.5 (0–20) mm, respectively (p < 0.001). Complications included anchor protrusion in five cases.

Conclusion

Arthroscopic suture bridge repair was useful for the treatment of displaced GT fractures with or without comminution and the management of the combined lesions. At the final follow-up, meaningful remodeling of the GT fracture and satisfactory clinical outcomes could be achieved.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Kristiansen B, Barfod G, Bredesen J, Erin-Madsen J, Grum B, Horsnaes MW, Aalberg JR (1987) Epidemiology of proximal humeral fractures. Acta Orthop Scand 58:75–77

    Article  CAS  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  3. Kim E, Shin HK, Kim CH (2005) Characteristics of an isolated greater tuberosity fracture of the humerus. J Orthop Sci 10:441–444. doi:10.1007/s00776-005-0924-6

    Article  CAS  PubMed  Google Scholar 

  4. Mattyasovszky SG, Burkhart KJ, Ahlers C, Proschek D, Dietz SO, Becker I, Muller-Haberstock S, Muller LP, Rommens PM (2011) Isolated fractures of the greater tuberosity of the proximal humerus: a long-term retrospective study of 30 patients. Acta Orthop 82:714–720. doi:10.3109/17453674.2011.618912

    Article  PubMed  PubMed Central  Google Scholar 

  5. Green A, Izzi J Jr (2003) Isolated fractures of the greater tuberosity of the proximal humerus. J Shoulder Elbow Surg 12:641–649. doi:10.1016/s1058274602868112

    Article  PubMed  Google Scholar 

  6. Neer CS 2nd (1970) Displaced proximal humeral fractures. I. Classification and evaluation. J Bone Joint Surg Am 52:1077–1089

    Article  PubMed  Google Scholar 

  7. Neer CS 2nd (1970) Displaced proximal humeral fractures. II. Treatment of three-part and four-part displacement. J Bone Joint Surg Am 52:1090–1103

    Article  PubMed  Google Scholar 

  8. 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 36:1185–1189. doi:10.1016/j.injury.2005.02.018

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  10. Kim SH, Ha KI (2000) Arthroscopic treatment of symptomatic shoulders with minimally displaced greater tuberosity fracture. Arthroscopy 16:695–700. doi:10.1053/jars.2000.9237

    Article  CAS  PubMed  Google Scholar 

  11. Bigliani L, Flatow E, Pollock R (1998) Fractures of the proximal humerus. In: Rockwood C, Matsen FA, Wirth MA, Harryman DT (eds) The Shoulder. Saunders. cop, Philadelphia

    Google Scholar 

  12. Park TS, Choi IY, Kim YH, Park MR, Shon JH, Kim SI (1997) A new suggestion for the treatment of minimally displaced fractures of the greater tuberosity of the proximal humerus. Bull Hosp Jt Dis 56:171–176

    CAS  PubMed  Google Scholar 

  13. Platzer P, Thalhammer G, Oberleitner G, Kutscha-Lissberg F, Wieland T, Vecsei V, Gaebler C (2008) Displaced fractures of the greater tuberosity: a comparison of operative and nonoperative treatment. J Trauma 65:843–848. doi:10.1097/01.ta.0000233710.42698.3f

    Article  PubMed  Google Scholar 

  14. 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 37:946–952. doi:10.1016/j.injury.2006.06.009

    Article  PubMed  Google Scholar 

  15. Bonsell S, Buford DA Jr (2003) Arthroscopic reduction and internal fixation of a greater tuberosity fracture of the shoulder: a case report. J Shoulder Elbow Surg 12:397–400. doi:10.1016/mse.2003.S1058274602000320

    Article  PubMed  Google Scholar 

  16. Maman E, Dolkart O, Chechik O, Amar E, Rak O, Rath E, Mozes G (2014) Arthroscopic findings of coexisting lesions with greater tuberosity fractures. Orthopedics 37:e272–e277. doi:10.3928/01477447-20140225-60

    Article  PubMed  Google Scholar 

  17. 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 73:1213–1218

    Article  CAS  PubMed  Google Scholar 

  18. Gartsman GM, Taverna E, Hammerman SM (1999) Arthroscopic treatment of acute traumatic anterior glenohumeral dislocation and greater tuberosity fracture. Arthroscopy 15:648–650. doi:10.1053/ar.1999.v15.0150642

    Article  CAS  PubMed  Google Scholar 

  19. 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 

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

    Article  PubMed  Google Scholar 

  21. Kim KC, Rhee KJ, Shin HD (2010) Arthroscopic treatment of symptomatic malunion of the greater tuberosity of the humerus using the suture-bridge technique. Orthopedics 33:242–245. doi:10.3928/01477447-20100225-13

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  23. Taverna E, Sansone V, Battistella F (2004) Arthroscopic treatment for greater tuberosity fractures: rationale and surgical technique. Arthroscopy 20:e53–e57

    Article  PubMed  Google Scholar 

  24. 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 83:1056–1062

    Article  CAS  PubMed  Google Scholar 

  25. Verdano MA, Aliani D, Pellegrini A, Baudi P, Pedrazzi G, Ceccarelli F (2013) Isolated fractures of the greater tuberosity in proximal humerus: does the direction of displacement influence functional outcome? An analysis of displacement in greater tuberosity fractures. Acta Biomed 84:219–228

    Google Scholar 

  26. Iannotti JP, Gabriel JP, Schneck SL, Evans BG, Misra S (1992) The normal glenohumeral relationships. An anatomical study of one hundred and forty shoulders. J Bone Joint Surg Am 74:491–500

    Article  CAS  PubMed  Google Scholar 

  27. Park SE, Ji JH, Shafi M, Jung JJ, Gil HJ, Lee HH (2014) Arthroscopic management of occult greater tuberosity fracture of the shoulder. Eur J Orthop Surg Traumatol 24:475–482. doi:10.1007/s00590-013-1212-3

    Article  PubMed  Google Scholar 

  28. Wang YP, Zhao JZ, Huangfu XQ, Liu WX, Jiang Y, Zhou XH, He YH (2012) Arthroscopic reduction and fixation for isolated greater tuberosity fractures. Chin Med J (Engl) 125:1272–1275

    Google Scholar 

  29. Lee SU, Jeong C, Park IJ (2012) Arthroscopic fixation of displaced greater tuberosity fracture of the proximal humerus. Knee Surg Sports Traumatol Arthrosc 20:378–380. doi:10.1007/s00167-011-1748-x

    Article  PubMed  Google Scholar 

  30. Duralde XA (2016) CORR insights((R)): Is arthroscopic technique superior to open reduction internal fixation in the treatment of isolated displaced greater tuberosity fractures? Clin Orthop Relat Res 474:1280–1282. doi:10.1007/s11999-016-4702-x

    Article  PubMed  Google Scholar 

  31. Liao W, Zhang H, Li Z, Li J (2016) Is arthroscopic technique superior to open reduction internal fixation in the treatment of isolated displaced greater tuberosity fractures? Clin Orthop Relat Res 474:1269–1279. doi:10.1007/s11999-015-4663-5

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  33. Wilcox RB 3rd, Arslanian LE, Millett PJ (2005) Management of a patient with an isolated greater tuberosity fracture and rotator cuff tear. J Orthop Sports Phys Ther 35:521–530. doi:10.2519/jospt.2005.35.8.521

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Daeheung-ro 64, Jung-gu, Daejeon, 302-823, Republic of Korea

    Jong-Hun Ji, Jae-Jung Jeong, Young-Yul Kim, Se-Won Lee & Sang-Eun Park

  2. Department of Orthopaedic surgery, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Republic of Korea

    Do-Yeol Kim

Authors
  1. Jong-Hun Ji
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jae-Jung Jeong
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Young-Yul Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Se-Won Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Do-Yeol Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Sang-Eun Park
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sang-Eun Park.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ji, JH., Jeong, JJ., Kim, YY. et al. Clinical and radiologic outcomes of arthroscopic suture bridge repair for the greater tuberosity fractures of the proximal humerus. Arch Orthop Trauma Surg 137, 9–17 (2017). https://doi.org/10.1007/s00402-016-2586-6

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-016-2586-6

Keywords

Search

Navigation