Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 7, 2022; 10(1): 117-127
Published online Jan 7, 2022. doi: 10.12998/wjcc.v10.i1.117
Minimally invasive open reduction of greater tuberosity fractures by a modified suture bridge procedure
Ling-Peng Kong, Juan-Juan Yang, Fu Wang, Fan-Xiao Liu, Yong-Liang Yang
Ling-Peng Kong, Fu Wang, Fan-Xiao Liu, Yong-Liang Yang, Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong Province, China
Juan-Juan Yang, Department of Radiotherapy, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan 250117, Shandong Province, China
Author contributions: Yang YL is the guarantor and designed the study; Kong LP and Yang JJ participated in the acquisition, analysis, and interpretation of the data, and drafted the initial manuscript; Wang F and Liu FX revised the article critically for important intellectual content.
Supported by China Scholarship Council, No. 201808080126; Incubation Fund of Shandong Provincial Hospital, No. 2020FY019; Young Scholars Program of Shandong Provincial Hospital; and Natural Science Foundation of Shandong Province, No. ZR202102180575.
Institutional review board statement: The study was reviewed and approved by the Shandong Provincial Hospital Affiliated to Shandong First Medical University Ethics Committee.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that they have no conflicting interests.
Data sharing statement: All data analyzed during this study are included in this published article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yong-Liang Yang, MD, PhD, Associate Chief Physician, Associate Professor, Surgeon, Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324 Jingwu Road, Jinan 250021, Shandong Province, China. yyljn@163.com
Received: June 18, 2021
Peer-review started: June 18, 2021
First decision: September 28, 2021
Revised: October 4, 2021
Accepted: November 26, 2021
Article in press: November 26, 2021
Published online: January 7, 2022
Processing time: 194 Days and 16.8 Hours
Abstract
BACKGROUND

Most greater tuberosity fractures can be treated without surgery but some have a poor prognosis. The surgical procedures for avulsion fractures of the humeral greater tuberosity include screw fixation, suture anchor fixation, and plate fixation, all of which have treatment-associated complications. To decrease surgical complications, we used a modified suture bridge procedure under direct vision and a minimally invasive small incision to fix fractures of the greater tuberosity of the humerus.

AIM

To investigate the clinical efficacy and outcomes of minimally invasive modified suture bridge open reduction of greater tuberosity evulsion fractures.

METHODS

Sixteen patients diagnosed between January 2016 and January 2019 with an avulsion-type greater tuberosity fracture of the proximal humerus and treated by minimally invasive open reduction and modified suture bridges with anchors were studied retrospectively. All were followed up by clinical examination and radiographs at 3 and 6 wk, 3, 6 and 12 mo after surgery, and thereafter every 6 mo. Outcomes were assessed preoperatively and postoperatively by a visual analog scale (VAS), the University of California Los Angeles (UCLA) shoulder score, the American Shoulder and Elbow Surgeon score (ASES), and range of motion (ROM) for shoulders.

RESULTS

Seven men and nine women, with an average age of 44.94 years, were evaluated. The time between injury and surgery was 1-2 d, with an average of 1.75 d. The mean operation time was 103.1 ± 7.23 min. All patients achieved bone union within 3 mo after surgery. VAS scores were significantly decreased (P = 0.002), and the mean degrees of forward elevation (P = 0.047), mean degrees of abduction (P = 0.035), ASES score (P = 0.092) were increased at 3 wk. The UCLA score was increased at 6 wk (P = 0.029) after surgery. The average degrees of external rotation and internal rotation both improved at 3 mo after surgery (P = 0.012 and P = 0.007, respectively). No procedure-related deaths or incision-related superficial or deep tissue infections occurred.

CONCLUSION

Modified suture bridge was effective for the treatment of greater tuberosity evulsion fractures, was easier to perform, and had fewer implants than other procedures.

Keywords: Minimally invasive; Greater tuberosity fracture; Open reduction; Suture bridge; Anchor

Core Tip: Greater tuberosity fractures are special proximal humerus fractures that are often accompanied by rotator cuff injury. We used a modified suture bridge procedure with a minimally invasive small incision under direct vision to fix fractures of the greater tuberosity. The technique reduces the risk of weakly or loosely fixed implants, and avoids secondary surgery to remove the screw and plate internal fixation. The limited incision and direct vision not only allows repair of rotator cuff injury but also eliminates the use of knotless anchors, reducing the cost of implants.