Clinical outcomes of a novel 'all-suture' fixation for valgus-impacted proximal humeral fractures

Abstract

Background: Conventional techniques for the fixation of displaced proximal humeral fractures include the use of locking plates, intramedullary nailing, hemiarthroplasty and reverse shoulder replacement. Valgus-impacted fractures are a common subtype of proximal humeral fracture, but there are few publications concerning the outcomes of treatment. This study aims to review outcomes following an 'all-suture' technique for this fracture subtype without the use of transosseous sutures.

Methods: All patients over the age of 18 who presented with 3- or 4-part valgus-impacted proximal humeral fractures and who underwent 'all-suture' repair at our centre were included. We reviewed their post-operative imaging and collected data on post-operative complications and patient-reported outcome measures.

Results: We identified 15 patients who had undergone all-suture fixation. The cohort's mean age was 56. Eleven patients were female. Eight patients had 3-part fractures and seven patients had 4-part fractures. There were no major post-operative complications. All fractures united. The mean Oxford Shoulder Score was 43.7 and the mean Single Assessment Numerical Evaluation score was 85.9 at the final follow-up.

Discussion: Our results suggest that all-suture fixation of proximal humeral fractures presents an attractive alternative to conventional techniques, whilst avoiding complications relating to metalwork implantation.

Keywords: humeral fixation; humerus; proximal humeral fracture; shoulder trauma; valgus impacted.

Figure 1.

Plain AP radiograph demonstrating a valgus-impacted proximal humeral fracture with significant displacement of the greater tuberosity.

Figure 2.

Plain AP post-operative radiograph demonstrating satisfactory post-operative reduction.

Figure 3.

Diagram showing the orientation of the sutures and maintenance of the reduction through buttressing of the humeral head by the GT and LT (rotator cuff not pictured).

Figure 4.

Diagram showing how the hoop stresses of the rotator cuff sutures maintain the fracture reduction.