Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Mar 11;3(2):e499-e504.
doi: 10.1016/j.asmr.2020.10.014. eCollection 2021 Apr.

Arthroscopic Reduction and Fixation With a Knotless Double-Row Construct Provides Good Results for Displaced Greater Tuberosity Fractures

Mohammad Bahman  1 , Vanessa Costil  2 , Mathilde Gaume  1 , Marc-Antoine Rousseau  1 , Patrick Boyer  1
Affiliations

Arthroscopic Reduction and Fixation With a Knotless Double-Row Construct Provides Good Results for Displaced Greater Tuberosity Fractures

Mohammad Bahman et al. Arthrosc Sports Med Rehabil. .

Abstract

Purpose: The purpose of the study is to describe the functional and structural outcomes of the arthroscopic 4-strand, knotless, double-row construct with suture tapes for the surgical treatment of displaced and/or comminuted greater tuberosity fractures of the humerus.

Methods: Patients were enrolled between December 2012 and January 2018. The main inclusion criteria were a comminuted and/or displaced tuberosity fracture with a displacement of at least 5 mm in any plane fixed under arthroscopy using a 4-strand, knotless, double-row construct. The technique involves reducing the displaced fragment with 2 medially placed, transtendinous anchors and compressing the greater tuberosity using the tapes from these medial anchors in 2 laterally placed anchors. The exclusion criteria were a fracture that was more than 10 days old at the time of surgery or a history of shoulder surgery and 3- or 4-part fractures. The postoperative rehabilitation protocol was similar for all patients. Constant scores, Quick Dash, return to work and sport, and complications were reported after a minimum follow-up period of 24 months. Bone healing was systematically evaluated on standardized radiographs, including lateral scapula view and anteroposterior views.

Results: Twenty-one patients were enrolled in this study. One patient did not complete the follow-up examination period and thus was excluded, leaving 20 patients in this study. At a median (SD) follow-up of 32 (9) months, the median (SD) Constant score was 94.7 (7.3) points, the median (SD) Quick Dash was 1.7 (4) points, and median (SD) visual analog scale score was 0.5 (1.4). All patients returned to previous work and sport level. No malunions or nonunions were seen. One conversion to open surgery was required for failure of the lateral row during surgery in a 62-year-old woman with osteopenic bone. Two patients experienced complex regional pain syndrome in the postoperative period that resolved after nonoperative treatment.

Conclusions: In this series, the use of arthroscopy combined with the biomechanical properties of knotless double-row constructs contributed to postoperative satisfactory functional results and healing of greater tuberosity fracture. In addition, range of motion was early, and no hardware removal was required. However, care should be taken with osteopenic bone where anchorage can fail.

Level of evidence: Level IV, case series.

PubMed Disclaimer

Figures

Fig 1
Fig 1
Drawing showing the principles of the arthroscopic fixation on a left shoulder.
Fig 2
Fig 2
(A) Lateral arthroscopic view of the displaced greater tuberosity fractures of the right shoulder. (B) Insertion of the medial anchorage with the tape. (C) Final arthroscopic view of the fracture fixed using the knotless double-row construct.
Fig 3
Fig 3
Displaced greater tuberosity fracture associated with anterior dislocation before (A, B) and after reduction (C, D) of a right shoulder.
Fig 4
Fig 4
(A) Magnetic resonance imaging (MRI) frontal view of the right shoulder showing comminuted displaced fracture with the supraspinatus tendon. (B) At the last follow-up, MRI of the right shoulder shows healed cuff and greater tuberosity fracture.
See this image and copyright information in PMC

References

    1. Braunstein V., Wiedemann E., Plitz W., Muensterer O.J., Mutschler W., Hinterwimmer S. Operative treatment of greater tuberosity fractures of the humerus—a biomechanical analysis. Clin Biomech (Bristol, Avon) 2007;22(6):652–657. - PubMed
    1. Song H.S., Williams G.R. Arthroscopic reduction and fixation with suture-bridge technique for displaced or comminuted greater tuberosity fractures. Arthroscopy. 2008;24(8):956–960. - PubMed
    1. Williams G.R., Wong K.L. Two-part and three-part fractures: Open reduction and internal fixation versus closed reduction and percutaneous pinning. Orthop Clin North Am. 2000;31(1):1–21. - PubMed
    1. Bahrs C., Lingenfelter E., Fischer F., Walters E.M., Schnabel M. Mechanism of injury and morphology of the greater tuberosity fracture. J Shoulder Elbow Surg. 2006;15:140–147. - PubMed
    1. Herscovici D., Saunders D.T., Johnson M.P., Sanders R., DiPasquale T. Percutaneous fixation of proximal humeral fractures. Clin Orthop Relat Res. 2000;375:97–104. - PubMed

LinkOut - more resources