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. 2025 Mar 31;17(3):e81514.
doi: 10.7759/cureus.81514. eCollection 2025 Mar.

Evaluation of a Novel Suture-Button Technique for Open Reduction and Internal Fixation in Isolated Fractures of the Greater Tuberosity of the Humerus: A Retrospective Study

Christos Koukos  1 , Dimitrios Giotis  2 , Michael Troullinakis  3 , Dimitrios Karadimos  1 , Paolo Arrigoni  4 , Emilios E Pakos  5 , Christos Lyrtzis  6 , Alexandros Tsitsikas  1 , Fredy Montoya  7
Affiliations

Evaluation of a Novel Suture-Button Technique for Open Reduction and Internal Fixation in Isolated Fractures of the Greater Tuberosity of the Humerus: A Retrospective Study

Christos Koukos et al. Cureus. .

Abstract

The purpose of the study is to present a novel technique for the open reduction and fixation of isolated displaced greater tuberosity (GT) fractures, utilizing a suture-button system, along with an evaluation of its efficacy. We conducted a retrospective study, including 18 patients with isolated tuberosity fractures displaced by more than 5 mm. All patients underwent surgical treatment using open reduction and internal fixation with a suture-button system (Zip Tight), reinforced with high-resistance sutures. The "Constant score," the "ASES (American Shoulder and Elbow Surgeons) score," and range of motion (ROM) were assessed postoperatively, with a minimum follow-up of 18 months. Postoperative X-rays were obtained in the anteroposterior (AP) view with the humerus in a neutral position, as well as in internal and external rotation and axial views. The "Constant score," the "ASES score," and ROM increased significantly, reaching their highest levels at the six-month follow-up and remaining stable up to the 12- and 18-month follow-ups. Postoperatively, the mean anterior flexion reached 145° (range: 100°-170°), and the mean abduction was 142° (range: 95°-170°). At 12 months, no patients exhibited significant problems with internal rotation, with the average reaching the T12 level (range: T7 to the posterior iliac crest). External rotation results were also very satisfactory, with a mean range of 75° (range: 60°-90°). Conclusively, this novel technique could provide a safe and effective surgical solution for the treatment of isolated GT fractures, with minimal complications and positive functional and radiological outcomes.

Keywords: greater tuberosity; humeral head fracture; rotator cuff; suture button; zip tight.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Isolated avulsion fracture of the greater tuberosity following an anteroinferior dislocation of the glenohumeral joint.
Figure 2
Figure 2. Zip-Tight Fixation System.
Figure 3
Figure 3. (A)-(B) Humeral head after reduction of the greater tuberosity fracture and fixation with Zip-Tight Fixation System.
Figure 4
Figure 4. (A) Patient with an isolated fracture of the greater tuberosity following an anteroinferior dislocation of the glenohumeral joint; (B) Postoperative image of the same patient.
See this image and copyright information in PMC

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