Fracture Avulsion of the Greater Tuberosity: Arthroscopic Transosseous Augmented Technique

Arthroscopic Tri-anchor Double-Pulley Suture-Bridge Reduction of Greater Tuberosity Fracture

Currently, cannulated screws, plates, and suture bridges are widely applied in the treatment of greater tuberosity fracture; however, further fragmentation of the fracture, risk of loss of fracture reduction, implant impingement, and anchor pullout are the drawbacks. Therefore, we present a pragmatic surgical technique called the arthroscopic tri-anchor double-pulley suture-bridge technique that uses a double-loaded metallic anchor as a lateral-row anchor. In the treatment of greater tuberosity fracture, this hybrid repair including 4 sets of double-pulley suture bridges and 2 sets of single rows can obtain powerful stiffness of the suture construct, the metallic anchor used as a lateral-row anchor can significantly reduce the risk of anchor pullout, the single-row process can lessen the overall surgical time, and implant impingement will not occur postoperatively.

Evaluation and Management of Pediatric Proximal Humerus Greater and Lesser Tuberosity Avulsion Fractures

Proximal humerus fractures account for 2% of fractures in skeletally immature patients. Avulsion fractures of the lesser and greater tuberosity are a rare subset of these injuries. Lack of awareness of these fracture types and subtle radiographic findings can result in delayed diagnosis and treatment. Case reports provide most of the current literature, and thus common injury mechanisms, clinical presentation, and ideal treatment time frame and modality are still undetermined. There are limited data directly comparing outcomes with nonsurgical or surgical management leading to unclear treatment guidelines. Presently, techniques for management of these injuries continue to evolve. Although these injuries represent a subset of pediatric proximal humerus injuries, they must be considered when evaluating a child with atraumatic and traumatic shoulder pain.

Arthroscopic Parachute Technique for Split-type Greater Tuberosity Fractures

Over the past years, several arthroscopic fixation procedures have been adopted for fractures of the greater tuberosity. Although they offer advantages over open approaches, especially for avulsion-type fixation, split-type fractures are usually treated with open reduction and internal fixation. However, suture constructs can result in a more reliable fixation system for multifragment or osteoporotic split-type fractures. Currently, the use of arthroscopic techniques in these more complex fractures is questionable due to inherent limitations of anatomic reduction and stability concerns. The authors report a technically simple and reproducible arthroscopic procedure based on anatomic, morphologic, and biomechanical concepts, which offers advantages over traditional open approaches or double-row arthroscopic techniques in the treatment of most split-type greater tuberosity fractures.

A Mid-Scapular Portal for Arthroscopic-Assisted Fixation of Severe Retraction Greater Tuberosity Avulsion Fracture

Chronic displaced greater tuberosity avulsion fracture of the humerus causes severe retraction of the rotator cuff and resorption of the avulsion fragment. Many treatment options can be considered to solve this problem and return the patient to function. The arthroscopic technique is very challenging to achieve a reduction of the rotator cuff and fixation of greater tuberosity with minimized soft-tissue damage. This Technical Note describes a portal for arthroscopic-assisted reduction and fixation in severe retracted greater tuberosity avulsion fracture. The technique is easy to release and fix chronic displaced greater tuberosity and could avoid unnecessary open surgery.