Published online Jul 31, 2009.
https://doi.org/10.12671/jkfs.2009.22.3.159
The Surgical Outcomes of Isolated Greater Tuberosity Fractures of the Proximal Humerus Fixed with the Spring Plate
Abstract
Purpose
The purpose of this study was to evaluate the surgical outcomes of isolated greater tuberosity fractures of the proximal humerus fixed with the spring plates.
Materials and Methods
Fourteen patients who could be followed up at least 1 year after the surgical treatment of isolated greater tuberosity fracture were evaluated. Their mean age was 51 years (range, 25~73 years). The deltopectoral approach and fixation with the spring plate were performed in all cases. The spring plate was used in all cases. In some circumstances, sutures incorporating the rotator cuff, interfragmentary screw or tension band wire were added. We evaluated the clinical outcomes using UCLA scoring system and KSS (Korean Shoulder Score).
Results
The mean UCLA score was 29.8 and the mean KSS was 89.4. The average time of bony union was 10.2 weeks (range, 7~14 weeks) after the surgery, including 1 case that was performed the secondary operation due to metal failure. The shoulder stiffness were observed in 4 cases and one case of infection was treated well without operation.
Conclusion
In the treatment of isolated greater tuberosity fractures of the proximal humerus, the spring plates fixation can be a good surgical option providing reliable functional results.
Fig. 1
(A~D) These photographs show the manufacturing process of spring plate. A appropriate-sized 1/3 tubular plate was selected, and cut at the end of screw hole.
Fig. 2
(A) Preoperative radiograph shows a displaced greater tuberosity fracture of the proximal humerus. (B) Postoperative immediate radiograph shows good reduction and fixation of the fracture with a spring plate. (C) Postoperative 7 weeks radiograph shows solid union without implant loosening and loss of reduction. (D~G) Photographs show near symmetric full forward flexion and internal rotation at final follow-up (postoperative 12 months).
A 49-years-old male sustained a isolated greater tuberosity fracture of the proximal humerus by a fall on the ground.
Fig. 3
(A) Eight weeks after trauma, a displaced greater tuberosity fracture of the proximal humerus was noticed on radiograph. (B, C) Reconstructed three-dimensional computerized tomography scans show marked displacement of fracture fragment impinging into subacromial space. (D) Postoperative immediate radiograph shows good reduction and fixation of the fracture with a spring plate. (E) Postoperative 13 weeks radiograph shows solid union without implant loosening and loss of reduction.
A 44-years-old male sustained multiple extremity fractures and subdural hemorrhage by a fall from a height. He lost his consciousness for several weeks.
Table 1
Patient demographics
References
-
Brien WW, Gellman H, Becker V, Garland DE, Waters RL, Wiss DA. Management of fractures of the humerus in patients who have an injury of the ipsilateral brachial plexus. J Bone Joint Surg Am 1990;72:1208–1210.
-
-
Chun JM, Kim SY, Oh SK, Kim JH, Choi JH. Deltopectoral approach for the operative treatment of fracture of the greater tuberosity of the proximal humerus. J Korean Soc Surg Hand 2003;8:28–32.
-
-
Flatow EL, Cuomo F, Maday MG, Miller SR, Mcllveen SJ, Bigliani LU. Open reduction and internal fixation of two-part displaced fractures of the greater tuberosity of the proximal part of the humerus. J Bone Joint Surg Am 1991;73:1213–1218.
-
-
Han SB, Park SW, Lee SH, Chung JW, Choi GW. The use of spring plates in management of acetabular posterior wall fractures. J Korean Hip Soc 2005;17:217–222.
-
-
Haryman DT II. In: Common surgical approaches to the shoulder In instructional course lectures. The America academy of orthopaedic surgeons. 3rd ed. Philadelphia: Harper Row; 1982. pp. 309.
-
-
Iannotti JP, Garbriel JP, Schneck SL, Evans BG, Misra S. The normal glenohumeral relationships. An anatoimical study of on hundred and forty shoulders. J Bone Joint Surg Am 1992;74:491–500.
-
-
Ihn JC, Kim PT, Shin DK. Hooked spring plate: its uses in posterior wall acetabular fracture fixation. J Korean Soc Fract 1994;7:606–615.
-
-
Ji JH, Kim YY, Kim WY, Park SE, Ra KH, Do JH. Arthroscopic treatment of greater tuberosity fracture-Preliminary Report-. J Korean Orthop Soc Sports Med 2007;6:57–65.
-
-
Lee KJ, Choi CH, Kim JM, et al. In: The Shoulder and elbow. 1st ed. Seoul, Korea: Young-Chang; 2007. pp. 676-679.
-
-
Lee KJ, Choi CH, Kim JM, et al. In: The Shoulder and elbow. 1st ed. Seoul, Korea: Young-Chang; 2007. pp. 290-291.
-
-
McLaughlin HL. Dislocation of the shoulder with tuberosity fracture. Surg Clin North Am 1963;43:1615–1620.
-
-
Moon ES, Kim MS, Kim YJ. The surgical outcomes for isolated greater tuberosity fracture of proximal humerus. J Korean Fract Soc 2007;20:239–245.
-
-
Olivier H, Dupare G, Romain F. Fractures of the greater tuberosity of the humerus. Orthop Trans 1986;10:223.
-
-
Park TS, Choi IY, Kim YH, Park MR, Shon JH, Kim SI. A new suggestion for the treatment of minimally displaced fractures of the greater tuberosity of the proximal humerus. Bull Hosp Jt Dis 1997;56:171–176.
-
-
Park TS, Kim TS, Park YS, Kim DH, Kang CN, Whang KS. The treatment of one-part fractures of the greater tuberosity of the proximal humerus. J Korean Shoulder Elbow Soc 1999;2:21–27.
-