Double-row suture anchors under arthroscopy for avulsion-type greater tuberosity fractures (Mutch type I)

doi:10.3969/j.issn.2095-4344.2017.19.009

Abstract

Abstract:

BACKGROUND: Greater tuberosity of humerus, as the attachment point of rotator cuff, plays a vital role in shoulder. Neer and AO classification for proximal humeral fractures have been accepted extensively. However, the classification for single greater tuberosity fractures of the proximal humerus is little reported, and its fixation method remains controversial.

OBJECTIVE: To explore the curative efficacy of the double-row suture anchors under arthroscopy for avulsion-type greater tuberosity fractures (Mutch type I)

METHODS: Clinical data of 24 patients with avulsion-type greater tuberosity fractures (Mutch type I) undergoing double-row suture anchors under arthroscopy were analyzed retrospectively. The displacement distance of the greater tuberosity of humerus was measured on CT before and after fixation. The shoulder joint was evaluated by Constant-Murley Score and the University of California, Los Angeles score at baseline, 1, 3, 6 and 12 months postoperatively. Besides, the visual analogue scale scores were detected at baseline and 12 months postoperatively.

RESULTS AND CONCLUSION: (1) Double-row suture anchors effectively improved the displacement of greater tuberosity and rotator cuff injury. (2) The patients accompanied by rotator cuff injury accounted for 79.16%. (3) The Constant-Murley Score and the University of California, Los Angeles scores were significantly improved at each time point (P < 0.05). The visual analogue scale scores after fixation were significantly superior to those before fixation (P < 0.05). (4) These results suggest that the double-row suture anchors under arthroscopy can effectively improve the displacement of greater tuberosity and alleviate the pain. Moreover, it is conductive for early recovery of the shoulder function with little trauma, so it is a good choice for avulsion-type greater tuberosity fractures (Mutch type I).

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Humerus, Features, Bone, Internal Fixators, Tissue Engineering

CLC Number:

R318

Liu Gang, Zhang Lei, Wang Guo-you, Zhou Xin, Zhang Tao, Guan Tai-yuan, Guo Xiao-guang, Fu Shi-jie. Double-row suture anchors under arthroscopy for avulsion-type greater tuberosity fractures (Mutch type I) [J]. Chinese Journal of Tissue Engineering Research, 2017, 21(19): 3005-3010.

Figures/Tables 2

References

[1] Rouleau DM, Mutch J, Laflamme GY,et al.Surgical Treatment of Displaced Greater Tuberosity Fractures of the Humerus.J Am Acad Orthop Surg.2016;24(1):46-56.

[2] Kannus P，Palvanen M，Niemi S,et al．Rate of proximal humeral fractures in older Finnish women between 1970 and 2007.Bone.2009;44(4):656-659．

[3] Maman E, Dolkart O, Chechik O,et al.Arthroscopic findings of coexisting lesions with greater tuberosity fractures.Orthopedics.2014;37(3):e272-277.

[4] DeBottis D, Anavian J, Green A,et al. Surgical management of isolated greater al.r tuberosity fractures of the proximal humerus. Orthop Clin North Am.2014;45(2):207-218.

[5] Lill H , Katthagen C, Jensen G, et al. Arthroscopic fracture management in proximal humeral fractures. Unfallchirurg. 2013;116(4):296-304.

[6] Taverna E , Sansone V, Battistella F, et al.Arthroscopic treatment for greater tuberosity fractures: rationale and surgical technique. Arthroscopy.2004;20(6):e53-57.

[7] George MS. Fractures of the greater tuberosity of the humerus. J Am Acad Orthop Surg.2007;15:607-613.

[8] Green A, Izzi J Jr. Isolated fractures of the greater tuberosity of the proximal humerus. J Shoulder Elbow Surg. 2003;12: 641-649.

[9] 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: 1185-1189.

[10] Bhatia DN,van Rooyen KS, du Toit DF,et al.Surgical treatment of comminuted,displaced fractures of the greater tuberosity of the proximal humerus: a new technique of double-row suture-anchor fixation and long-term results. Injury 2006;37: 946-952.

[11] Neer CS 2nd. Displaced proximal humeral fractures. I. Classification and evaluation. J Bone Joint Surg Am. 1970; 52(6):1077-1089.

[12] Mutch J, Laflamme GY, Hagemeister N,eta1.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.

[13] Bahrs C,Rolauffs B,Dietz K,et al. Clinical and radiological evaluation of minimally displaced proximal humeral fractures. Arch Orthop Trauma Surg.2010;130(5):673-679.

[14] Xiang M , Chen H, Tang HC,et al. Treatment of two-part proximal humeral fracture with closed or mini-open assisted reduction and percutaneous pinning. Zhongguo Gu Shang. 2008;21(12):919-921.

[15] Popp D, Schöffl V, Strecker W,et al. Osteosynthesis of displaced fractures of the greater tuberosity with the Bamberg plate. Oper Orthop Traumatol. 2016;28(5):392-401.

[16] Park TS, Choi IY, Kim YH,et al. A new suggestion for the treatment of minimally displaced fractures ofthe greater tuberosity of the proximal humerus. Bull Hosp Jt Dis. 1997; 56(3):171-176.

[17] Handoll HH , Brorson S.Interventions for treating proximal humeral fractures in adults.Cochrane Database Syst Rev. 2015;(11):CD000434.

[18] Platzer P,Thalhammer G, Oberleitner G,et al.Displaced fractures of the greater tuberosity: a comparison of operative and nonoperative treatment.J Trauma. 2008;65(4):843-848.

[19] Rath E, Alkrinawi N, Levy O,et al.Minimally displaced fractures of the greater tuberosity: outcome of non-operative treatment.J Shoulder Elbow Surg.2013;22(10):e8-e11.

[20] Rouleau DM, Mutch J, Laflamme GY,et al.Surgical treatment of displaced greater tuberosity fractures of the humerus. J Am Acad Orthop Surg.2016;24(1): 46-56.

[21] Kim DH, Elattrache NS, Tibone JE, et al.Biomechanical comparison of a single-row versus double-row suture anchortechnique for rotator cuff repair.Am J Sports Med.2006; 34(407-414.)

[22] Kim SJ,Jung M,Lee JH ,et al.Arthroscopic repair of a significant (>50%) partial-thickness subscapularis tear concomitant with a full-thickness supraspinatus tear: technical considerations for subscapularis repair (transtendon technique versus tear completion).J Shoulder Elbow Surg. 2015;24(6):875-881.

[23] Lin CL,Su FC ,Chang CH,et al. Effect of shoulder abduction on the fixation of humeral greater tuberosity fractures: a biomechanical study for three types of fixation constructs. J Shoulder Elbow Surg.2015;24(4):547-554.

[24] Yang J Jr , Robbins M , Reilly J ,et al. The Clinical Effect of a Rotator Cuff Retear: A Meta-analysis of Arthroscopic Single-Row and Double-Row Repairs. Am J Sports Med. 2016 Jul 14. pii: 0363546516652900.

[25] Park SE , Jeong JJ, Panchal K,et al. Arthroscopic-assisted plate fixation for displaced large-sized comminuted greater tuberosity fractures of proximal humerus: a novel surgical technique. Knee Surg Sports Traumatol Arthrosc.2015 Sep 29. [Epub ahead of print].

[26] Liao W,Zhang H,Li Z,et al. Is Arthroscopic Technique Superior to Open Reduction Internal Fixation in the Treatment of Isolated Displaced Greater Tuberosity Fractures?. Clin Orthop Relat Res. 2016;474(5):1269-1279.

[27] Duralde XA.CORR Insights: Is Arthroscopic Technique Superior to Open Reduction Internal Fixation in the Treat-ment of Isolated Displaced Greater Tuberosity Fractures? Clin Orthop Relat Res. 2016;474(5):1280-1282.

[28] Ji JH ,Jeong JJ , Kim YY,et al.Clinical and radiologic outcomes of arthroscopic suture bridge repair for the greater tuberosity fractures of the proximal humerus.Arch Orthop Trauma Surg. 2017;137(1):9-17.

[29] Gupta YS ,Ali S ,Ling S.Tendon pathology in trauma CT imaging: an under-recognized entity.Emerg Radiol. 2016; 23(5):513-520.

[30] Li R, Cai M, Tao K.Arthroscopic reduction and fixation for displaced greater tuberosity fractures using the modified suture-bridge technique.Int Orthop.2017;41(6):1257-1263.