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
ARTICLE HIGHLIGHTS
Research background

Most greater tuberosity fractures can be treated without surgery but some have a poor prognosis. The main surgical procedures for avulsion fractures of the humeral greater tuberosity are screw fixation, suture anchor fixation, and plate fixation; there are some complications after surgery.

Research motivation

Our experience with repair of rotator cuff injuries by the suture bridge technique led us adapt it to fixation of fractures of the greater tuberosity of the humerus using a modified minimally invasive small incision under direct vision. The aim was to improve patient care and reduce surgical complications.

Research objectives

The purpose of the study was to describe a modified minimally invasive surgical technique for the treatment of avulsion fractures of the greater tuberosity of the humerus. To this end, we investigated the clinical efficacy and outcomes of the procedure.

Research methods

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

Research results

All patients achieved bone union within 3 mo after surgery. VAS scores significantly decreased within 3 wk after surgery (P = 0.002). The mean degrees of forward elevation increased at 3 wk (P = 0.047). The mean degrees of abduction, ASES and UCLA scores increased at 6 wk (P = 0.035, P = 0.092 and P = 0.029, respectively). The average degrees of external and internal rotation improved at 3 mo (P = 0.012 and P = 0.007, respectively).

Research conclusions

Minimally invasive open reduction of avulsion fractures of the greater tuberosity of the humerus by a modified suture bridge with anchors yielded an acceptable clinical result, with firm fixation and allowed early postoperative passive shoulder movement. The technique requires fewer implants, is a simpler procedure, and is easier to begin using compared with other techniques. It is an effective and reliable method for the treatment of avulsion fractures of the greater tuberosity of the humerus.

Research perspectives

This retrospective study lacked a control group using other fixation techniques, such as locking compression plates or arthroscopic fixation. Further evaluation of the effectiveness of our minimally invasive suture bridge open reduction technique for the treatment of fractures of the greater tuberosity requires accumulation of more cases, longer follow-up, and inclusion of a control group using other treatment methods.