Short-term functional outcome of arthroscopic reduction and fixation with cannulated screws and/or suture-bridge technique with double-row suture anchor for fractures of greater tuberosity / 中华骨科杂志

ABSTRACT

Objective To evaluate the short-term functional outcome of arthroscopic reduction and fixation for fractures of greater tuberosity of humerus.Methods From May 2012 to December 2016,data of 25 cases with fractures of greater tuberosity of humerus who were treated by reduction and fixation under arthroscopy were retrospectively analyzed.There were 12 males and 13 females,with an average age of 44.8 years (22-69 years),including 7 cases of left shoulder,and 18 cases of right shoulder.X-ray examinations revealed that the displacement of the greater tuberosity was 5-12 mm,with an average of 5.8 mm.There were 21 cases of fresh fractures and 4 cases of old fractures (more than 3 weeks from injury to operation).5 patients were treated only using cannulated screw fixation(Group one),while 12 patients only using suture-bridge anchor fixation(Group two) and another 8 patients were treated using combination technique with cannulated screw and suture anchor fixation(Group three).There were glenoid fractures in 11 cases before surgery,and 9 cases were found with Bankart lesion,1 case SLAP injury,8 cases rotator cuff tear found under arthroscopic examinations.At the last visit,visual analogue scale (VAS) pain score,American Shoulder & Elbow Surgeons (ASES) score and Constant-Murley score were collected to evaluate the recovery of shoulder function.Results All the incision healed primary,and no infection occurred.All 25 patients were followed up for an average period of 21.3 months (6～38 months).The X-ray showed that the fractures of the great tuberosity of humerus and the glenoid healed 2-4 months after operation,with an average time of 3.4 months.No fracture displacement and absorption were observed.At the final follow-up,the average functions of shoulder were 175.0°±6.3°,170.0°±9.5° and 160.6°±27.4° in group one,two and three respectively for forward flex-ion;57.5°±13.0°,56.1°±14.5° and 53.1°±11.2° for lateral external rotation in group one,two and three respectively;0.3±0.4,0.8± 1.1 and 1.1±1.4 points for VAS in group one,two and three respectively;98±1.6,95.6±4.0 and 93.3±7.5 points for ASES in group one,two and three respectively;and 96.5±2.3,95.0±4.3 and 92.0±9.2 points for the Constant-Murley scoring system in group one,two and three respectively.The displacement of the lateral anchor occurred in 1 patient (75 points for ASES,69 points for Constant -Murley and 3 points for VAS);and no complications such as internal fixation failure,fracture displacement and neurovascular injury occurred in the remaining patients.Conclusion It is a safe and effective method to treat the fractures of great tuberosity of humerus by reduction and fixation under the arthroscope using cannulated screws and/or suture anchors.