Summary

Tension bridge fixation could be useful technique for the treatment of displaced fractures of the greater tuberosity of the proximal humerus especially to the osteoporasis patient. Don't worry about anchor pulling out and migration of the fractured fragment.

Abstract

a)Background, Open reduction and the cannulated screw/plate fixation technique have been commonly used to treat a displaced greater tuberosity fracture. But the fragments are thin and broken easily. It is difficult to restore and also lead to associated morbidity such as further comminution or migration of the fractured fragment and poor fixation. Bone fragments displacement after operation is not rare because of the tension of the rotate cuff. With recent advances in arthroscopy, arthroscopic reduction and the double-row suture anchor fixation technique have been reported. Poor fixation such as anchor pulling out with osteoporosis patients is also a problem. We modify the method of fixation of double row technique by drilling a hole at the cortex of the lateral margin of the fracture to fix the sutures instead of the anchor insertion which is named “tension bridge fixation”. b) Material, From January 2013 to December 2014, 8 osteoporosis patients with displaced greater tuberosity fracture were treat with this technique, 2 of them had linear fracture of surgical neck of humerus. c) Method, A routine arthroscopic examination of the intra-articular joint was undertaken through the posterior and anterior portals, and the displaced greater tuberosity fragment attached to the supraspinatus was detected. Then arthroscope was moved into the subacromial space and a bursectomy was performed, particularly around the lateral margin of the fracture and the adjacent intact metaphyseal cortex. Make sure the center of the greater tuberosity by needle, then make the incision of the lateral deltoid minimally invasive approach. Then put the two anchors as posssible as close to subchondral bone, passed the sutures through the full thickness of the supraspinatus tendon–tuberosity junction. After reduction of the fracture fragment, the sutures are tied. After drilling a hole at the cortex of the lateral margin of the fracture, one of the four tied sutures are put through the hole and tied with anther four sutures. Now the sutures net are made over the fragments and press to the fracture bone bed. d) Results, All fracture are healing.The ROM: excellent 6, good 2. No pain7; a little, 1. No migration of the fractured fragment is happen. e) Discussion, Putting the medial anchor in close to subchondral bone can reduce the risk of the pulling out the anchor. Sutures passed through the bone–tendon junction of the fragment and tied can make the sutures crossed over the bone fragment bed. Sutures through the hole locked to the lateral cortex can fix the fragments like “tension bridge”. f) Conclusion, This technique could be useful for the treatment of displaced fractures of the greater tuberosity of the proximal humerus especially to the osteoporasis patient. Don't worry about anchor pulling out and migration of the fractured fragment.