Effectiveness of open reduction and locking compression hook plate in treatment of isolated humeral greater tuberosity fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LONG Cheng ¹ ,  XIANG Zhou ¹ , ZHONG Gang ¹ , CEN Shiqiang ¹ , KUANG Song ² , HE Changchun ³ , JIANG Tao ⁴ , HUANG Fuguo ¹

1. Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China;
2. Department of Orthopedics, the Second People’s Hospital of Longquanyi District, Chengdu Sichuan, 610108, P.R.China;
3. Department of Orthopedics, Sichuan HuaYingShan Guang Neng Ltd. General Hospital, Guangan Sichuan, 638600, P.R.China;
4. Department of Orthopedics, Modern Hospital of Sichuan, Chengdu Sichuan, 610000, P.R.China;

Corresponding author：

XIANG Zhou, Email: xiangzhou15@hotmail.com

Keywords：

Humeral greater tuberosity fracture; open reduction; locking compression hook plate; internal fixation

DOI：

10.7507/1002-1892.201810119

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Objective To observe the effectiveness of locking compression hook plate in treatment of humeral greater tuberosity fractures. Methods Between March 2014 and September 2017, 16 patients with isolated humeral greater tuberosity fractures were terated with open reduction and internal fixation with locking compression hook plates. There were 11 males and 5 females, with an average age of 38.4 years (range, 22-67 years). The cause of injury was falling injury in 13 cases and sport injury in 3 cases. All patients were closed fractures. Of all patients, 14 patients accompanied with shoulder joint dislocations. CT scan showed the average displacement of fragment was 12.6 mm (range, 8-21 mm) after reduction. All patients began passive functional exercise at 3 days after operation. Results Primary healing of the incisons achieved in all patients, without complications such as infection and nerve injury. All patients were followed up 12-20 months (mean, 15.3 months). At 3 months after operation, X-ray film showed that all fractures achieved bone union, all of which met the imaging anatomical reduction standard. According to the Neer scoring criteria, 11 cases were excellent and 5 cases were good at last follow-up. One patint presented slight pain of shoulder joint and mild activity limitation, which relieved after 1 year. Conclusion The method of open reduction and locking compression hook plate internal fixation for isolated humeral greater tuberosity fractures has advantages, such as less intraoperative hemorrhage, mild postoperative pain, firm fixation, and allowing patients to perform functional exercise earlier, which is conducive to shoulder functional recovery and obtain satisfactory effectiveness.

Citation： LONG Cheng, XIANG Zhou, ZHONG Gang, CEN Shiqiang, KUANG Song, HE Changchun, JIANG Tao, HUANG Fuguo. Effectiveness of open reduction and locking compression hook plate in treatment of isolated humeral greater tuberosity fractures. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(4): 436-439. doi: 10.7507/1002-1892.201810119 Copy

1.	Kim E, Shin HK, Kim CH. Characteristics of an isolated greater tuberosity fracture of the humerus. J Orthop Sci, 2005, 10(5): 441-444.
2.	Gruson KI, Ruchelsman DE, Tejwani NC. Isolated tuberosity fractures of the proximal humeral: current concepts. Injury, 2008, 39(3): 284-298.
3.	李文庆, 张作君, 刘云龙. 肱骨近端脱套样骨折治疗体会. 中国修复重建外科杂志, 2018, 32(12): 1540-1544.
4.	Green A, Izzi J Jr. Isolated fractures of the greater tuberosity of the proximal humerus. J Shoulder Elbow Surg, 2003, 12(6): 641-649.
5.	Williams GR Jr, Wong KL. Two-part and three-part fractures: open reduction and internal fixation versus closed reduction and percutaneous pinning. Orthop Clin North Am, 2000, 31(1): 1-21.
6.	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(10): 1185-1189.
7.	Yin B, Moen TC, Thompson SA, et al. Operative treatment of isolated greater tuberosity fractures: retrospective review of clinical and functional outcomes. Orthopedics, 2012, 35(6): e807-e814.
8.	Mutch J, Laflamme GY, Hagemeister N, et al. 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.
9.	Neer CS 2nd. Displaced proximal humeral fractures: part Ⅰ. Classification and evaluation. 1970. Clin Orthop Relat Res, 2006, (442): 77-82.
10.	Mason BJ, Kier R, Bindleglass DF. Occult fractures of the greater tuberosity of the humerus: radiographic and MR imaging findings. AJR Am J Roentgenol, 1999, 172(2): 469-473.
11.	Gumina S, Carbone S, Postacchini F. Occult fractures of the greater tuberosity of the humerus. Int Orthop, 2009, 33(1): 171-174.
12.	Zanetti M, Weishaupt D, Jost B, et al. MR imaging for traumatic tears of the rotator cuff: high prevalence of greater tuberosity fractures and subscapularis tendon tears. AJR Am J Roentgenol, 1999, 172(2): 463-467.
13.	Mattyasovszky SG, Burkhart KJ, Ahlers C, et al. Isolated fractures of the greater tuberosity of the proximal humerus: a long-term retrospective study of 30 patients. Acta Orthop, 2011, 82(6): 714-720.
14.	White EA, Skalski MR, Patel DB, et al. Isolated greater tuberosity fractures of the proximal humerus: anatomy, injury patterns, multimodality imaging, and approach to management. Emerg Radiol, 2018, 25(3): 235-246.
15.	Patten RM, Mack LA, Wang KY, et al. Nondisplaced fractures of the greater tuberosity of the humerus: sonographic detection. Radiology, 1992, 182(1): 201-204.
16.	Rutten MJ, Jager GJ, de Waal Malefijt MC, et al. Double line sign: a helpful sonographic sign to detect occult fractures of the proximal humerus. Eur Radiol, 2007, 17(3): 762-767.
17.	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.
18.	Schöffl 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): 509-512.
19.	Dimakopoulos P, Panagopoulos A, Kasimatis G, et al. Anterior traumatic shoulder dislocation associated with displaced greater tuberosity fracture: the necessity of operative treatment. J Orthop Trauma, 2007, 21(2): 104-112.
20.	Gaudelli C, Ménard J, Mutch J, et al. 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): 1003-1008.

1. Kim E, Shin HK, Kim CH. Characteristics of an isolated greater tuberosity fracture of the humerus. J Orthop Sci, 2005, 10(5): 441-444.
2. Gruson KI, Ruchelsman DE, Tejwani NC. Isolated tuberosity fractures of the proximal humeral: current concepts. Injury, 2008, 39(3): 284-298.
3. 李文庆, 张作君, 刘云龙. 肱骨近端脱套样骨折治疗体会. 中国修复重建外科杂志, 2018, 32(12): 1540-1544.
4. Green A, Izzi J Jr. Isolated fractures of the greater tuberosity of the proximal humerus. J Shoulder Elbow Surg, 2003, 12(6): 641-649.
5. Williams GR Jr, Wong KL. Two-part and three-part fractures: open reduction and internal fixation versus closed reduction and percutaneous pinning. Orthop Clin North Am, 2000, 31(1): 1-21.
6. 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(10): 1185-1189.
7. Yin B, Moen TC, Thompson SA, et al. Operative treatment of isolated greater tuberosity fractures: retrospective review of clinical and functional outcomes. Orthopedics, 2012, 35(6): e807-e814.
8. Mutch J, Laflamme GY, Hagemeister N, et al. 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.
9. Neer CS 2nd. Displaced proximal humeral fractures: part Ⅰ. Classification and evaluation. 1970. Clin Orthop Relat Res, 2006, (442): 77-82.
10. Mason BJ, Kier R, Bindleglass DF. Occult fractures of the greater tuberosity of the humerus: radiographic and MR imaging findings. AJR Am J Roentgenol, 1999, 172(2): 469-473.
11. Gumina S, Carbone S, Postacchini F. Occult fractures of the greater tuberosity of the humerus. Int Orthop, 2009, 33(1): 171-174.
12. Zanetti M, Weishaupt D, Jost B, et al. MR imaging for traumatic tears of the rotator cuff: high prevalence of greater tuberosity fractures and subscapularis tendon tears. AJR Am J Roentgenol, 1999, 172(2): 463-467.
13. Mattyasovszky SG, Burkhart KJ, Ahlers C, et al. Isolated fractures of the greater tuberosity of the proximal humerus: a long-term retrospective study of 30 patients. Acta Orthop, 2011, 82(6): 714-720.
14. White EA, Skalski MR, Patel DB, et al. Isolated greater tuberosity fractures of the proximal humerus: anatomy, injury patterns, multimodality imaging, and approach to management. Emerg Radiol, 2018, 25(3): 235-246.
15. Patten RM, Mack LA, Wang KY, et al. Nondisplaced fractures of the greater tuberosity of the humerus: sonographic detection. Radiology, 1992, 182(1): 201-204.
16. Rutten MJ, Jager GJ, de Waal Malefijt MC, et al. Double line sign: a helpful sonographic sign to detect occult fractures of the proximal humerus. Eur Radiol, 2007, 17(3): 762-767.
17. 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.
18. Schöffl 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): 509-512.
19. Dimakopoulos P, Panagopoulos A, Kasimatis G, et al. Anterior traumatic shoulder dislocation associated with displaced greater tuberosity fracture: the necessity of operative treatment. J Orthop Trauma, 2007, 21(2): 104-112.
20. Gaudelli C, Ménard J, Mutch J, et al. 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): 1003-1008.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness of open reduction and locking compression hook plate in treatment of isolated humeral greater tuberosity fractures

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