ARTHROSCOPOIC FIXATION WITH PERCUTANEOUS CANNULATED SCREWS FOR ACUTE DISPLACED ISOLATED GREATER TUBEROSITY FRACTURES OF THE PROXIMAL HUMERUS_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 XIZhijie ¹ , LIANGQianqian ^2,3 , MIKun ⁴ , FENGZhibin ⁴ , WANGBin ⁴

1. Department of Orthopaedics, Shanghai Guanghua Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai, 200052, P. R. China;
2. Department of Orthopedics, Longhua Hospital, Shanghai University of Traditional Chinese Medicine;
3. Institute of Spine, Shanghai University of Traditional Chinese Medicine;
4. the Second Department of Orthopaedics, the First Affiliated Hospital, University of Guangxi Traditional Chinese Medicine;

Corresponding?author：

XIZhijie, Email: zjx0222@163.com

Keywords：

Greater tuberosity fracture of humerus; Arthroscope; Cannulated screw

DOI：

10.7507/1002-1892.20150001

Video：

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Objective To evaluate the technique and the effectiveness of arthroscopic fixation with percutaneous cannulated screws for acute displaced isolated greater tuberosity fractures of the proximal humerus. Methods A retrospective analysis was made on the clinical data of 15 patients with acute displaced isolated greater tuberosity fractures of the proximal humerus, who accepted arthroscopic percutaneous cannulated screw fixation treatment between January 2010 and February 2013. There were 8 males and 7 females with an average age of 44.9 years (range, 31-66 years). Eight left shoulders and 7 right shoulders were affected. The mean interval of injury and operation was 9.9 days (range, 4-19 days). Before operation, the average range of motion (ROM) values of the affected shoulder were (74.13±17.19)° in forward flexion, (121.67±17.50)° in abduction, (T11±2)° in internal rotation, and (39.27±8.08)° in external rotation; the visual analogue scale (VAS) score was 6.46±1.30; and Costant score was 62.27±11.90. Results Operations were all successfully completed and incision healed by first intention in all cases. All cases were followed up 12-27 months (mean, 15 months). Postoperative X-ray films showed good reduction, alignment, and union of fracture. The average fracture healing time was 8 weeks (range, 6-13 weeks). At last follow-up, the ROM of the affected shoulder were significantly improved to (169.33±7.99)° in forward flexion, (156.67±10.47)° in abduction, (T6±2)° in internal rotation, and (71.67±7.94)° in external rotation (P<0.05); the VAS score was significantly reduced to 1.73±1.02 (t=-8.51, P=0.00); and the Costant score was significantly increased to 96.20±2.34 (t=11.50, P=0.00). No complication was found, such as neural or vascular injury, infection, shoulder joint adhesion, fixation failure, or fracture displacement. Conclusion Arthroscopic fixation with percutaneous cannulated screws is a safe method to treat acute displaced isolated greater tuberosity fractures of the proximal humerus, and it has good short-term effectiveness with the advantages of little trauma and satisfactory functional recovery.

Citation： XIZhijie, LIANGQianqian, MIKun, FENGZhibin, WANGBin. ARTHROSCOPOIC FIXATION WITH PERCUTANEOUS CANNULATED SCREWS FOR ACUTE DISPLACED ISOLATED GREATER TUBEROSITY FRACTURES OF THE PROXIMAL HUMERUS. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(1): 1-5. doi: 10.7507/1002-1892.20150001 Copy

1.	Bahrs C, Lingenfelter E, Fischer F, et al. Mechanism of injury and morphology of the greater tuberosity fracture. J Shoulder Elb Surg, 2006, 15(2):140-147.
2.	Ji JH, Kim WY, Ra KH. Arthroscopic double-row suture anchor fixation of minimally displaced greater tuberosity fractures. Arthroscopy, 2007, 23(10):1131. e1-4.
3.	Kim E, Shin HK, Kim CH. Characteristics of an isolated greater tuberosity fracture of the humerus. J Orthop Sci, 2005, 10(5):441-444.
4.	Gruson KI, Ruchelsman DE, Tejwani NC. Isolated tuberosity fractures of the proximal humerus:current concepts. Injury, 2008, 39(3):284-298.
5.	George MS. Fractures of the greater tuberosity of the humerus. J Am Acad Orthop Surg, 2007, 15(10):607-613.
6.	Fahmy A, Antonakopoulos N, Khan A. Acromial impression fracture of the greater tuberosity with massive rotator cuff tear:this need not be a nightmare! BMJ Case Rep, 2011, doi:10.1136/bcr.11.2010.3521.
7.	Mason BJ, Kier R, Bindleglass DF. Occult fractures of the greater tuberosity of the humerus:radiographic and MR imaging findings. AJR Am J Roentgenol, 1999, 172(2):469-473.
8.	Ogawa K, Yoshida A, Ikegami H. Isolated fractures of the greater tuberosity of the humerus:solutions to recognizing a frequently overlooked fracture. J Trauma, 2003, 54(4):713-717.
9.	Mutch J, Laflamme GY, Hagemeister N, et al. A new morphological classification for greater tuberosity fractures of the proximal humerus:validation and clinical implications. Bone Joint J, 2014, 96-B(5):646-651.
10.	Jellad A, Bouaziz MA, Boudokhane S, et al. Isolated greater tuberosity fracture:Short-term functional outcome following a specific rehabilitation program. Ann Phys Rehabil Med, 2012, 55(1):16-24.
11.	Platzer P, Kutscha-Lissberg F, Lehr S, et al. The influence of displacement on shoulder function in patients with minimally displaced fractures of the greater tuberosity. Injury, 2005, 36(10):1185-1189.
12.	Neer CS 2nd. Displaced proximal humeral fractures:part I. Classification and evaluation. 1970. Clin Orthop Relat Res, 2006, (442):77-82.
13.	Bigliani LU, Flatow EL, Pollock RG. Fractures of the proximal humerus//Rockwood CA Jr, Green DP, Bucholz RW, eds. Rockwood and Green's Fractures in Adults. Philadelphia:Lippincott-Raven, 1996:1055-1107.
14.	Park TS, Choi IY, Kim YH, et al. A new suggestion for the treatment of minimally displaced fractures of the greater tuberosity of the proximal humerus. Bull Hosp Jt Dis, 1997, 56(3):171-176.
15.	Pauly S, Herrmann S, Perka C, et al. Arthroscopic refixation of a combined fracture of the greater and lesser tuberosity of the proximal humerus. Knee Surg Sports Traumatol Arthrosc, 2013, 21(5):1171-1175.
16.	Kim SH, Ha KI. Arthroscopic treatment of symptomatic shoulders with minimally displaced greater tuberosity fracture. Arthroscopy, 2000, 16(7):695-700.
17.	Bonsell S, Buford DA Jr. Arthroscopic reduction and internal fixation of a greater tuberosity fracture of the shoulder:a case report. J Shoulder Elbow Surg, 2003, 12(4):397-400.
18.	黨育, 付中國, 蘆浩, 等. 關節鏡治療肩關節脫位合并肱骨大結節骨折近期療效. 中國修復重建外科雜志, 2009, 23(3):271-273.
19.	何耀華, 趙金忠, 皇甫小橋, 等. 肩關節鏡輔助下治療急性肱骨大結節骨折. 中華醫學雜志, 2010, 90(21):1494-1496.
20.	Ji JH, Shafi M, Song IS, et al. Arthroscopic fixation technique for comminuted, displaced greater tuberosity fracture. Arthroscopy, 2010, 26(5):600-609.
21.	Green A, Izzi J Jr. Isolated fractures of the greater tuberosity of the proximal humerus. J Shoulder Elbow Surg, 2003, 12(6):641-649.
22.	Cadet ER, Ahmad CS. Arthroscopic reduction and suture anchor fixation for a displaced greater tuberosity fracture:a case report. J Shoulder Elbow Surg, 2007, 16(4):e6-9.
23.	劉玉杰, 王志剛, 李眾力, 等. 關節鏡技術在關節外手術的臨床應用. 解放軍醫學雜志, 2003, 28(3):275-276.
24.	Bhatia DN, de Beer JF, van Rooyen KS. The bony partial articular surface tendon avulsion lesion:an arthroscopic technique for fixation of the partially avulsed greater tuberosity fracture. Arthroscopy, 2007, 23(7):781. e1-6.

1. Bahrs C, Lingenfelter E, Fischer F, et al. Mechanism of injury and morphology of the greater tuberosity fracture. J Shoulder Elb Surg, 2006, 15(2):140-147.
2. Ji JH, Kim WY, Ra KH. Arthroscopic double-row suture anchor fixation of minimally displaced greater tuberosity fractures. Arthroscopy, 2007, 23(10):1131. e1-4.
3. Kim E, Shin HK, Kim CH. Characteristics of an isolated greater tuberosity fracture of the humerus. J Orthop Sci, 2005, 10(5):441-444.
4. Gruson KI, Ruchelsman DE, Tejwani NC. Isolated tuberosity fractures of the proximal humerus:current concepts. Injury, 2008, 39(3):284-298.
5. George MS. Fractures of the greater tuberosity of the humerus. J Am Acad Orthop Surg, 2007, 15(10):607-613.
6. Fahmy A, Antonakopoulos N, Khan A. Acromial impression fracture of the greater tuberosity with massive rotator cuff tear:this need not be a nightmare! BMJ Case Rep, 2011, doi:10.1136/bcr.11.2010.3521.
7. Mason BJ, Kier R, Bindleglass DF. Occult fractures of the greater tuberosity of the humerus:radiographic and MR imaging findings. AJR Am J Roentgenol, 1999, 172(2):469-473.
8. Ogawa K, Yoshida A, Ikegami H. Isolated fractures of the greater tuberosity of the humerus:solutions to recognizing a frequently overlooked fracture. J Trauma, 2003, 54(4):713-717.
9. Mutch J, Laflamme GY, Hagemeister N, et al. A new morphological classification for greater tuberosity fractures of the proximal humerus:validation and clinical implications. Bone Joint J, 2014, 96-B(5):646-651.
10. Jellad A, Bouaziz MA, Boudokhane S, et al. Isolated greater tuberosity fracture:Short-term functional outcome following a specific rehabilitation program. Ann Phys Rehabil Med, 2012, 55(1):16-24.
11. Platzer P, Kutscha-Lissberg F, Lehr S, et al. The influence of displacement on shoulder function in patients with minimally displaced fractures of the greater tuberosity. Injury, 2005, 36(10):1185-1189.
12. Neer CS 2nd. Displaced proximal humeral fractures:part I. Classification and evaluation. 1970. Clin Orthop Relat Res, 2006, (442):77-82.
13. Bigliani LU, Flatow EL, Pollock RG. Fractures of the proximal humerus//Rockwood CA Jr, Green DP, Bucholz RW, eds. Rockwood and Green's Fractures in Adults. Philadelphia:Lippincott-Raven, 1996:1055-1107.
14. Park TS, Choi IY, Kim YH, et al. A new suggestion for the treatment of minimally displaced fractures of the greater tuberosity of the proximal humerus. Bull Hosp Jt Dis, 1997, 56(3):171-176.
15. Pauly S, Herrmann S, Perka C, et al. Arthroscopic refixation of a combined fracture of the greater and lesser tuberosity of the proximal humerus. Knee Surg Sports Traumatol Arthrosc, 2013, 21(5):1171-1175.
16. Kim SH, Ha KI. Arthroscopic treatment of symptomatic shoulders with minimally displaced greater tuberosity fracture. Arthroscopy, 2000, 16(7):695-700.
17. Bonsell S, Buford DA Jr. Arthroscopic reduction and internal fixation of a greater tuberosity fracture of the shoulder:a case report. J Shoulder Elbow Surg, 2003, 12(4):397-400.
18. 黨育, 付中國, 蘆浩, 等. 關節鏡治療肩關節脫位合并肱骨大結節骨折近期療效. 中國修復重建外科雜志, 2009, 23(3):271-273.
19. 何耀華, 趙金忠, 皇甫小橋, 等. 肩關節鏡輔助下治療急性肱骨大結節骨折. 中華醫學雜志, 2010, 90(21):1494-1496.
20. Ji JH, Shafi M, Song IS, et al. Arthroscopic fixation technique for comminuted, displaced greater tuberosity fracture. Arthroscopy, 2010, 26(5):600-609.
21. Green A, Izzi J Jr. Isolated fractures of the greater tuberosity of the proximal humerus. J Shoulder Elbow Surg, 2003, 12(6):641-649.
22. Cadet ER, Ahmad CS. Arthroscopic reduction and suture anchor fixation for a displaced greater tuberosity fracture:a case report. J Shoulder Elbow Surg, 2007, 16(4):e6-9.
23. 劉玉杰, 王志剛, 李眾力, 等. 關節鏡技術在關節外手術的臨床應用. 解放軍醫學雜志, 2003, 28(3):275-276.
24. Bhatia DN, de Beer JF, van Rooyen KS. The bony partial articular surface tendon avulsion lesion:an arthroscopic technique for fixation of the partially avulsed greater tuberosity fracture. Arthroscopy, 2007, 23(7):781. e1-6.

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Chinese Journal of Reparative and Reconstructive Surgery

ARTHROSCOPOIC FIXATION WITH PERCUTANEOUS CANNULATED SCREWS FOR ACUTE DISPLACED ISOLATED GREATER TUBEROSITY FRACTURES OF THE PROXIMAL HUMERUS

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