Arthroscopic Reduction and Internal Fixation of Proximal Humerus Greater Tuberosity Fracture

Abstract

Proximal humerus fractures are common fractures that may occur after ground level falls or other traumatic events resulting in a direct injury to the shoulder. Depending on the fracture morphology and the age of the patient, anatomic reduction can vastly improve outcomes, especially in fracture patterns that involve the greater tuberosity. In this case example, we performed a minimally invasive, arthroscopic reduction and fixation of a proximal humerus fracture that involved significant displacement of the greater tuberosity. The technique employed is reproducible and avoids the morbidity of a large open incision while simultaneously providing compression of the fracture fragment for excellent healing potential.

Fig 1

Anteroposterior radiograph view of the right shoulder demonstrating a displaced proximal humerus greater tuberosity fracture (depicted by blue arrow).

Fig 2

Intraoperative image of a right shoulder in the beach chair position when viewing from a posterolateral portal into the subacromial space toward the greater tuberosity fracture. The fracture fragment is evident above the motorized shaver (blue arrow) with the fracture bed of the greater tuberosity evident below the shaver.

Fig 3

Intraoperative image of a right shoulder in the beach chair position viewing from a posterolateral portal in the subacromial space looking at the fracture bed (bed indicated by blue arrow). One of two individual 4.5-mm PEEK corkscrew anchors is inserted in the fracture bed medially just adjacent to the articular cartilage of the humeral head. (PEEK, polyether ether ketone.)

Fig 4

Intraoperative image of the right shoulder in the beach chair position viewing from a posterolateral portal in the subacromial space at the fracture bed directly inferior in this photo with a single doubly loaded Arthrex 4.5-mm Corkscrew PEEK anchor with white and blue FiberWire—blue FiberWire evident on the very left side of the screen (blue arrow). Nitinol wire, seen coming from the left side of the photo retrograde through the rotator cuff from a 90° suture lasso, allows for suture passage. (PEEK, polyether ether ketone.)

Fig 5

Intraoperative image of the right shoulder in beach chair position viewing from the subacromial space. Two FiberWire sutures from an anterior anchor (anterior white, middle blue) and a single suture from a posterior anchor (posterior blue) have been passed through the rotator cuff and are docked in the lateral portal (blue arrow). A punch is brought in to create a pilot hole along the humerus distal to the fracture bed.

Fig 6

Intraoperative image of the right shoulder in the beach chair position viewing from a posterolateral portal into the subacromial space looking into the lateral gutter (blue arrow). A 4.75-mm SwiveLock anchor is visualized being inserted laterally along the humerus.

Fig 7

Intraoperative image of the right shoulder in beach chair position viewing from the lateral portal into the subacromial space towards the repaired greater tuberosity fracture fragment. An “X” configuration (blue arrow) is evident with crossing suture strands from the anterior/posterior anchors then placed laterally into lateral row SwiveLock anchors. Excellent fracture reduction is obtained and compression along the FiberWire.

Fig 8

Postoperative anteroposterior radiograph of a right shoulder demonstrating reduced greater tuberosity fracture (blue arrow) after arthroscopic fixation.