ABSTRACT
Objective:
To compare the
clinical effectiveness between arthroscopic hollow screws combined with a
suture anchor, hollow screws and proximal
humerus internal locking system (PHILOS) in the
treatment of split-type fractures of
humeral greater tuberosity.
Methods:
A
retrospective study was conducted to analyze the 54
patients with split-type fracture of
humeral greater tuberosity who had been admitted to Department of
Joint Surgery,
Hospital of
Traditional Chinese Medicine, Affiliated to Southwest Medical
University from May 2015 to August 2020. There were 17
males and 37
females with an age of (58.4±12.1) years. According to different
treatment methods, they were divided into 3 groups. Group A of 18 cases was treated with arthroscopic hollow screws combined with a
suture anchor, group B of 18 cases with hollow screws, and group C of 18 cases with PHILOS. The length of
surgical incision, and range of
shoulder motion, visual analogue scale (VAS), and American
Shoulder and
Elbow Surgeons (ASES) score at the last follow-up were recorded and compared between the 3 groups.
Results:
There was no statistically significant difference in the preoperative general information between the 3 groups, indicating the 3 groups were comparable ( P>0.05). The
surgical incision in group A [(0.7±0.1) cm] was the shortest, followed by (5.0±1.4) cm in group B, and (12.8±2.1) cm in group C, showing statistically significant differences in pairwise comparison ( P<0.05). In the 3 groups at the last follow-up, respectively, the
shoulder forward flexion was 159.7°±13.4°, 154.9°±16.2°, and 160.5°±12.9°, and the
shoulder abduction 149.6°±11.3°, 142.4°±12.0°, and 145.1°±10.4°, showing no statistically significant difference among the 3 groups ( P>0.05); the external
rotation was 41.1°±8.1°, 38.1°±7.8° and 43.7°±6.2°, showing a statistically significant difference between groups B and C ( P<0.05); the dorsal extension was T 12 (L 5 to T 6), T 12 (L 5 to T 7), and T 12 (L 3 to T 6), showing no statistically significant difference among the 3 groups ( P>0.05). There was no statistically significant difference among the 3 groups in the VAS score or ASES score at the last follow-up ( P>0.05). Respectively, there were 2, 6, and 4
patients in groups A, B and C
who developed
complications, showing statistically significant differences between the 3 groups ( P<0.05).
Conclusions:
In the
treatment of split fractures of
humeral greater tuberosity, arthroscopic hollow screws combined with a
suture anchor, hollow screws and PHILOS can all relieve
pain and restore
joint function of the
shoulder. However, arthroscopic hollow screws combined with a
suture anchor are the most recommendable due to their advantages in minimally invasiveness and reduction in
complications.