Using Plate Osteosynthesis to Treat Isolated Greater Tuberosity Fractures
Isolated greater tuberosity fractures make up a small subset of proximal humerus fractures.
We conducted a study to evaluate the radiologic and clinical outcomes of patients who underwent a novel use of plate osteosynthesis in the treatment of displaced greater tuberosity fractures. Eleven consecutive patients with a displaced greater tuberosity fracture were treated. Mean age at surgery was 60.3 years old (range, 37-71 years).
Mean follow-up was 27 months (range, 16-44 months). All 11 patients experienced radiographic union. Three of the 11 had a loss of anatomical reduction. Mean Penn Shoulder Score was 79, and mean Single Assessment Numeric Evaluation score was 72. At most recent follow-up, mean forward elevation was 147°, and mean external rotation was 25°.
Plate osteosynthesis is a novel technique for the treatment of displaced greater tuberosity fractures. This technique resulted in excellent fracture reduction, a 100% union rate, minimal fracture migration, and good return of range of motion.
Our technique supplements the literature on greater tuberosity fracture fixation by using a plate as the point for suture fixation rather than suture anchors or screw fixation. As has been shown with 3- and 4-part fractures, plate osteosynthesis provides proximal suture fixation points and locking screws (often in poor-quality bone) that can prevent suture cut-out and isolated screw failure. In addition, compared with other techniques for greater tuberosity fixation, meta-diaphyseal cortical plate fixation bypasses the often poor bone quality of the greater tuberosity, preventing these modes of failure.18 Schoffl and colleagues18 reported on 10 patients who received a Bamberg plate; all 10 had excellent postoperative outcomes with no complications or secondary loss of reduction. Outcomes in the present study mirror those in the literature for operative fixation of displaced greater tuberosity fractures. Despite the near anatomical reduction in the majority of patients (mean forward elevation, 147°), functional results in this patient population remain guarded, with many patients reporting only good clinical outcomes.
This study had a few limitations. First is the inherent limitation of a retrospective study. Second, the small sample size limited the subgroup analysis. However, given the rarity of the injury and the single-surgeon series, we would have to have added considerable time to the study to increase its power. Third, there was no control group. This is a difficult situation with displaced fractures, as clinical outcomes are poorer with nonoperative management than with operative intervention.2,16,17 Compared with historical operative controls in the literature, our patients compare favorably over medium-term follow-up.2,5,15,16
Conclusion
Plate osteosynthesis is a novel technique in the treatment of displaced greater tuberosity fractures. It results in excellent fracture reduction, a 100% union rate, minimal fracture migration, and good return of ROM. However, self-reported functional assessment of the shoulder was about three-fourths of what is expected of normal or preinjury function.
