Arthroscopic Revision Repair of Displaced Greater Tuberosity Fracture

Abstract

Recurrent displacement of a greater tuberosity fracture fragment after an attempt at open reduction internal fixation is a rare but troublesome complication. This can lead to persistent pain, stiffness, lack of overhead function, and the possible need for revision surgery. Benefits of an arthroscopic revision surgery are numerous and include improved visualization of the fracture fragments, minimal soft tissue disruption, ability to address concurrent glenohumeral joint pathology, and decreased blood loss. This technique highlights the unique scenario of performing an arthroscopic revision greater tuberosity fracture repair to a pre-existing lateral humerus plate.

Fig 1

Anteroposterior radiographs of the left shoulder. (A) The immediate postoperative films from a greater tuberosity open reduction internal fixation. (B) The 2-week clinic radiograph with posterosuperior displacement of the greater tuberosity fragment.

Fig 2

Arthroscopic images of the left shoulder through a standard posterior viewing portal. (A) The fracture bed of the displaced greater tuberosity fragment with exposed lateral locking screws. (B) The displaced greater tuberosity fragment medially retracted with humeral head cartilage exposed inferiorly.

Fig 3

Arthroscopic images of the left shoulder through a standard posterior viewing portal. (A) An arthroscopic suture shuttling device introduced from the lateral portal through the suture holes on the humeral plate. (B) A reduced greater tuberosity fragment secured to the plate with arthroscopic suture fixation.

Fig 4

Intraoperative fluoroscopic image of the left shoulder after the greater tuberosity has been reduced and repaired to the lateral plate. Notice the reduction of the greater tuberosity fragment back to its anatomic position.