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Hook Plate Fixation for Isolated Greater Tuberosity Fractures of the Humerus

  • Lee, Kyoung-Rak (Department of Orthopedic Surgery, Dongsan Medical Center, Keimyung University School of Medicine) ;
  • Bae, Ki-Cheor (Department of Orthopedic Surgery, Dongsan Medical Center, Keimyung University School of Medicine) ;
  • Yon, Chang-Jin (Department of Orthopedic Surgery, Dongsan Medical Center, Keimyung University School of Medicine) ;
  • Cho, Chul-Hyun (Department of Orthopedic Surgery, Dongsan Medical Center, Keimyung University School of Medicine)
  • Received : 2017.11.01
  • Accepted : 2017.11.02
  • Published : 2017.12.31

Abstract

Background: The purpose of this study was to investigate the outcomes after fixation using a 3.5-mm locking compression plate (LCP) hook plate for isolated greater tuberosity (GT) fractures of the proximal humerus. Methods: We evaluated the postoperative radiological and clinical outcomes in nine patients who were followed up at least 1 year with isolated GT fractures. Using the deltopectoral approach, we fixed the displaced GT fragments with a 3.5-mm LCP hook plate (Synthes, West Chester, PA, USA). Depending on the fracture patterns, the hook plate was fixed with or without augmentation using either tension suture or suture anchor fixation. Results: All the patient showed successful bone union. The mean time-to-union was 11 weeks. The radiological and clinical outcomes at the final follow-up were generally satisfactory. The mean visual analogue scale for pain, the University of California at Los Angeles score, the American Shoulder and Elbow Surgeons score, and the subjective shoulder value were 1.4, 30.3, 84.3, and 82.2%, respectively. The mean active forward flexion, abduction, external rotation, and internal rotation of the shoulder were $156.7^{\circ}$, $152.2^{\circ}$, $61.1^{\circ}$, and the 10th thoracic vertebral level, respectively. Only one patient presented with a postoperative complication of shoulder stiffness. The patient was treated through arthroscopic capsular release on the 5th postoperative month. Conclusions: We conclude that fixation using 3.5-mm LCP hook plates for isolated GT fractures of the proximal humerus is a useful treatment method that provides satisfactory clinical and radiological outcomes.

Keywords

References

  1. Green A, Izzi J Jr. Isolated fractures of the greater tuberosity of the proximal humerus. J Shoulder Elbow Surg. 2003;12(6):641-9. https://doi.org/10.1016/S1058-2746(02)86811-2
  2. Gruson KI, Ruchelsman DE, Tejwani NC. Isolated tuberosity fractures of the proximal humeral: current concepts. Injury. 2008;39(3):284-98. https://doi.org/10.1016/j.injury.2007.09.022
  3. Chen YF, Zhang W, Chen Q, Wei HF, Wang L, Zhang CQ. AO X-shaped midfoot locking plate to treat displaced isolated greater tuberosity fractures. Orthopedics. 2013;36(8):e995-9. https://doi.org/10.3928/01477447-20130724-13
  4. Park SE, Jeong JJ, Panchal K, Lee JY, Min HK, Ji JH. Arthroscopic-assisted plate fixation for displaced large-sized comminuted greater tuberosity fractures of proximal humerus: a novel surgical technique. Knee Surg Sports Traumatol Arthrosc. 2016;24(12):3892-8. https://doi.org/10.1007/s00167-015-3805-3
  5. Brais G, Menard J, Mutch J, Laflamme GY, Petit Y, Rouleau DM. Transosseous braided-tape and double-row fixations are better than tension band for avulsion-type greater tuberosity fractures. Injury. 2015;46(6):1007-12. https://doi.org/10.1016/j.injury.2015.02.007
  6. Cho NS, Moon SC, Rhee YG. Clinical results of various surgical techniques for isolated fracture of greater tuberosity of humerus. J Korean Fract Soc. 2013;26(2):133-9. https://doi.org/10.12671/jkfs.2013.26.2.133
  7. Bockmann B, Buecking B, Eschbach DA, Franz D, Ruchholtz S, Mohr J. Fixation of the greater tuberosity in proximal humeral fractures: FiberWire(R) or wire cerclage? Acta Orthop Belg. 2015;81(1):9-16.
  8. Gillespie RJ, Johnston PS, Gordon VA, Ward PJ, Getz CL. Using plate osteosynthesis to treat isolated greater tuberosity fractures. Am J Orthop (Belle Mead NJ). 2015;44(8):E248-51.
  9. Schoffl V, Popp D, Strecker W. A simple and effective implant for displaced fractures of the greater tuberosity: the "Bamberg" plate. Arch Orthop Trauma Surg. 2011;131(4):509-12. https://doi.org/10.1007/s00402-010-1175-3
  10. Shin DJ, Byun YS, Chang SA, Yun HM, Park HW, Park JY. The surgical outcomes of isolated greater tuberosity fractures of the proximal humerus fixed with the spring plate. J Korean Fract Soc. 2009;22(3):159-65. https://doi.org/10.12671/jkfs.2009.22.3.159
  11. McLaughlin-Symon I, Kenyon P, Morgan B, Ravenscroft M. A new "trapdoor technique" for fixation of displaced greater tuberosity fractures of the shoulder. J Hand Microsurg. 2015;7(2):241-3. https://doi.org/10.1007/s12593-015-0190-6
  12. Mutch J, Laflamme GY, Hagemeister N, Cikes A, Rouleau DM. A new morphological classification for greater tuberosity fractures of the proximal humerus: validation and clinical implications. Bone Joint J. 2014;96(5):646-51.
  13. Neer CS 2nd. Displaced proximal humeral fractures. Part I. Classification and evaluation. By Charles S. Neer, I, 1970. Clin Orthop Relat Res. 1987;(223):3-10.
  14. Park TS, Choi IY, Kim YH, Park MR, Shon JH, Kim SI. 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):171-6.
  15. Platzer P, Kutscha-Lissberg F, Lehr S, Vecsei V, Gaebler C. The influence of displacement on shoulder function in patients with minimally displaced fractures of the greater tuberosity. Injury. 2005;36(10):1185-9. https://doi.org/10.1016/j.injury.2005.02.018
  16. Hebert-Davies J, Mutch J, Rouleau D, Laflamme GY. Delayed migration of greater tuberosity fractures associated with anterior shoulder dislocation. J Orthop Trauma. 2015;29(10):e396-400. https://doi.org/10.1097/BOT.0000000000000343
  17. Moon ES, Kim MS, Kim YJ. The surgical outcomes for isolated greater tuberosity fracture of proximal humerus. J Korean Fract Soc. 2007;20(3):239-45. https://doi.org/10.12671/jkfs.2007.20.3.239
  18. Gaudelli C, Menard J, Mutch J, Laflamme GY, Petit Y, RouleauDM. Locking plate fixation provides superior fixation of humerus split type greater tuberosity fractures than tension bands and double row suture bridges. Clin Biomech (Bristol, Avon). 2014;29(9):1003-8. https://doi.org/10.1016/j.clinbiomech.2014.08.013
  19. Lee SK, Park JS, Choy WS. Locking compression plate distal ulna hook plate as alternative fixation for fifth metatarsal base fracture. J Foot Ankle Surg. 2014;53(5):522-8. https://doi.org/10.1053/j.jfas.2014.02.021
  20. Cho CH, Jung GH, Song KS. Tension suture fixation using 2 washers for proximal humeral fractures. Orthopedics. 2012;35(3):202-5. https://doi.org/10.3928/01477447-20120222-05
  21. Cho CH, Kim DH, Kim BS. Radiographic and clinical results of tension suture fixation using two washers with PHILOS plate for proximal humeral fractures. Injury. 2017;48(2):464-8. https://doi.org/10.1016/j.injury.2016.11.030