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Abstract
Purpose
To evaluate the adequate surgical methods and postoperative rehabilitation by analyzing the outcome of surgical treatment for isolated greater tuberosity fracture of proximal humerus.
Materials and Methods
Ten patients who allowed at least 1 year follow up after the surgical treatment of isolated greater tuberosity fractures were evaluated. Their mean age was 52.3 years (range, 28~67) and mean follow up duration was 23.8 months (range, 12~36). We choosed the different approaches and fixation methods according to size, location and presence of comminution of the fragment, and combined injury. The rehabilitation programs were indivisualized and we evaluated the clinical outcomes using UCLA and Constant scoring system.
Results
According to the UCLA scoring system, 5 cases were excellent, 3 cases were satisfactory, and 2 cases were unsatisfactory. By the Constant scoring system, 8 cases were excellent and 2 cases were good. The average bony union time was 7.6 weeks (range, 6~8) except the 2 cases of revision surgery. Two cases were operated using cannulated screws alone, 3 cases using only nonabsorbable sutures and 5 cases using cannulated screws and nonabsorbable sutures. One out of two revision cases was developed from the negligence of preoperative shoulder anterior dislocation with rupture of subscapularis, and the other was caused by improper immobilization of the fracture site postoperatively.
Conclusion
Not only the adequate surgical approaches and the fixation methods according to the size and comminution of fragment, but also the identification of combined injuries were very important in the surgical treatment for the isolated greater tuberosity fracture. And we considered that the adequate postoperative rehabilitation and proper protection based on the intraoperative fixation stability play an important role for the better clinical and radiological outcomes.
Figures and Tables
Fig. 1
(A) 46-year-old male and his initial anteroposterior and external rotational radiographs show isolated greater tuberosity fracture.
(B) Immediate postoperative radiograph shows fracture fixation using one cannulated screw through the deltopectoral approach.
(C) But, anterior shoulder dislocation was developed at postoperative 1 day.
(D) The initial anterposterior radiograph obtained from the local hospital shows the previous existence of anterior shoulder dislocation.
(E) MRI showed the complete subscapularis tear.
(F) At 2 years 8 months after fracture fixation using tension band suturing with nonabsorbable sutures and subscapularis repair with suture anchors, the radiograph shows good fracture healing.
Fig. 2
(A) 43-year-old female and her initial anteroposterior radiograph show isolated greater tuberosity fracture with anterior shoulder dislocation.
(B) After closed reduction, anteroposterior radiograph and CT scan were checked.
(C) Immediate postoperative radiograph shows the fracture fixation using two cannulated screws through the deltoid splitting approach.
(D) At postoperative 2 weeks, subarachnoid hemorrhage was developed and neurosurgery was performed. The follow up radiograph after neurosurgery shows fixation loss of fracture fragment.
(E) She underwent the revision surgery for greater tuberosity fracture using tension band suturing with nonabsorbable suture through the same approach and the radiograph at 3 year after operation shows good fracture healing.
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