Published online Jan 7, 2022. doi: 10.12998/wjcc.v10.i1.117
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
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.
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.
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.
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 radio
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).
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.
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.