Minimally invasive open reduction of greater tuberosity fractures by a modified suture bridge procedure

BACKGROUND

Most greater tuberosity fractures can be treated without surgery but some have a poor prognosis. The surgical procedures for avulsion fractures of the humeral greater tuberosity include screw fixation, suture anchor fixation, and plate fixation, all of which have treatment-associated complications. To decrease surgical complications, we used a modified suture bridge procedure under direct vision and a minimally invasive small incision to fix fractures of the greater tuberosity of the humerus.

AIM

To investigate the clinical efficacy and outcomes of minimally invasive modified suture bridge open reduction of greater tuberosity evulsion fractures.

METHODS

Sixteen patients diagnosed between January 2016 and January 2019 with an avulsion-type greater tuberosity fracture of the proximal humerus and treated by minimally invasive open reduction and modified suture bridges with anchors were studied retrospectively. All were followed up by clinical examination and radiographs at 3 and 6 wk, 3, 6 and 12 mo after surgery, and thereafter every 6 mo. Outcomes were assessed preoperatively and postoperatively by a visual analog scale (VAS), the University of California Los Angeles (UCLA) shoulder score, the American Shoulder and Elbow Surgeon score (ASES), and range of motion (ROM) for shoulders.

RESULTS

Seven men and nine women, with an average age of 44.94 years, were evaluated. The time between injury and surgery was 1-2 d, with an average of 1.75 d. The mean operation time was 103.1 ± 7.23 min. All patients achieved bone union within 3 mo after surgery. VAS scores were significantly decreased (P = 0.002), and the mean degrees of forward elevation (P = 0.047), mean degrees of abduction (P = 0.035), ASES score (P = 0.092) were increased at 3 wk. The UCLA score was increased at 6 wk (P = 0.029) after surgery. The average degrees of external rotation and internal rotation both improved at 3 mo after surgery (P = 0.012 and P = 0.007, respectively). No procedure-related deaths or incision-related superficial or deep tissue infections occurred.

CONCLUSION

Modified suture bridge was effective for the treatment of greater tuberosity evulsion fractures, was easier to perform, and had fewer implants than other procedures.

[A histopathologic study on lacrimal gland in Sjögren's syndrome]

Biopsy specimens of palpebral lacrimal glands from 15 cases of Sjögren's syndrome (SS) were studied by light and transmission electron microscopy. Six cases without any symptoms or signs of dry eyes were used as the control. The main changes of SS included: (1) massive infiltration of lymphocytes; (2) atrophy of lacrimal glandular follicles and ducts in various degrees; (3) degeneration and necrosis of glandular epithelium; and (4) proliferation of connective tissue. Lymphatic infiltration indicates that the damage of the glandular tissue might be related to autoimmune pathogenesis. According to the histopathologic findings, the authors divide SS into three stages which are basically consistent with their clinical presentations.