![]() ![]() In cases with early healing or retraction, careful mobilization of the fragment may be required before reduction. To maximize healing potential, the fracture bed can be gently debrided using an arthroscopic shaver. Close attention is paid to the size, comminution, and direction of displacement for the greater tuberosity fragment. The camera is switched to the lateral portal, providing excellent visualization of the fracture fragment and rotator cuff. An arthroscopic acromioplasty also may be carried out at the discretion of the surgeon. An arthroscopic shaver is used to perform a subacromial bursectomy to improve visualization and ease of instrument passage. The subacromial space is entered and a lateral portal is established after spinal needle localization. A diagnostic arthroscopy is performed and any intra-articular pathology is addressed. An anterosuperior portal is created in outside-in fashion through the rotator interval. A standard posterior portal is created and a 30-degree arthroscope is introduced into the glenohumeral joint. The operative extremity is prepped in standard fashion and bony anatomic landmarks are referenced when establishing arthroscopic portals. We describe a technique for arthroscopic fixation of greater tuberosity fractures using a suture anchor-based construct, along with several technical tips to maximize success with this procedure. Thin or comminuted fractures that will not accept screw fixation can be addressed with arthroscopic suture fixation, preserving the potential for bone-to-bone healing and reducing the risk of hardware failure. Additional benefits of arthroscopic fixation include intra-articular access for diagnosing and treating other shoulder pathology, reduced radiation exposure, decreased blood loss, and a smaller surgical scar. 7, 10, 11, 12 Arthroscopic repair can be more technically demanding and time-consuming, although similarities to rotator cuff repair may decrease the learning curve. Several arthroscopic techniques and implants have been described including single-row, double-row, and suture bridge constructs. Likewise, an arthroscopic approach affords the opportunity to visualize the entire joint, identify any additional pathology, and treat such conditions arthroscopically as indicated. 9 recently reported a high rate of postoperative stiffness after mini-open screw fixation, with 31% of patients requiring reoperation for arthroscopic release and manipulation.Īrthroscopic fixation avoids deltoid disruption and open dissection while still allowing excellent visualization and manipulation of the fracture. 8 Disadvantages of this approach include increased soft-tissue dissection, a larger surgical scar, increased infection risk and loss of motion. 3 Benefits of an open approach include excellent visualization, technical ease, and high rates of bony union. Fixation can be achieved with cancellous screws and washers, plate and screw constructs, all-suture constructs, or suture anchors. Open reduction and internal fixation (ORIF) allows direct visualization of the fracture and surrounding anatomy via a deltoid-split or deltopectoral approach. 5, 6 In surgical cases, accurate reduction of the fracture is important to optimize rotator cuff function and prevent subacromial impingement. 5, 6 Surgical fixation is recommended for displacement greater than 5 mm in the general population or 3 mm in high-demand patients, such as athletes or overhead laborers. 3, 4 The vast majority (85%-95%) of these fractures are minimally displaced and can be managed conservatively with good results. Due to the rotator cuff attachments on the fragment, displacement tends to occur superiorly and posteriorly. 1, 2 In contrast to comminuted fragility fractures, these fractures often occur in younger patients and may be associated with glenohumeral dislocation. Isolated greater tuberosity fractures of the humerus account for approximately 20% of proximal humerus fractures. ![]()
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