A comparative study of three internal fixation techniques for split fractures of humeral greater tuberosity
Liu Gang, Luo Hong, Zhang Baolu, Tang Weili, Liu Yang, Qin Bo, Deng Kai, Zeng Shengqiang, Bao Dingsu, Fu Shijie
Abstract
ObjectiveTo compare the clinical effectiveness between arthroscopic hollow screws combined with a suture anchor, hollow screws and proximal humerus internal locking system (PHILOS) in the treatment of split-type fractures of humeral greater tuberosity.
MethodsA retrospective study was conducted to analyze the 54 patients with split-type fracture of humeral greater tuberosity who had been admitted to Department of Joint Surgery, Hospital of Traditional Chinese Medicine, Affiliated to Southwest Medical University from May 2015 to August 2020. There were 17 males and 37 females with an age of (58.4±12.1) years. According to different treatment methods, they were divided into 3 groups. Group A of 18 cases was treated with arthroscopic hollow screws combined with a suture anchor, group B of 18 cases with hollow screws, and group C of 18 cases with PHILOS. The length of surgical incision, and range of shoulder motion, visual analogue scale (VAS), and American Shoulder and Elbow Surgeons (ASES) score at the last follow-up were recorded and compared between the 3 groups.
ResultsThere was no statistically significant difference in the preoperative general information between the 3 groups, indicating the 3 groups were comparable (P>0.05). The surgical incision in group A [(0.7±0.1) cm] was the shortest, followed by (5.0±1.4) cm in group B, and (12.8±2.1) cm in group C, showing statistically significant differences in pairwise comparison (P<0.05). In the 3 groups at the last follow-up, respectively, the shoulder forward flexion was 159.7°±13.4°, 154.9°±16.2°, and 160.5°±12.9°, and the shoulder abduction 149.6°±11.3°, 142.4°±12.0°, and 145.1°±10.4°, showing no statistically significant difference among the 3 groups (P>0.05); the external rotation was 41.1°±8.1°, 38.1°±7.8° and 43.7°±6.2°, showing a statistically significant difference between groups B and C (P<0.05); the dorsal extension was T12 (L5 to T6), T12 (L5 to T7), and T12 (L3 to T6), showing no statistically significant difference among the 3 groups (P>0.05). There was no statistically significant difference among the 3 groups in the VAS score or ASES score at the last follow-up (P>0.05). Respectively, there were 2, 6, and 4 patients in groups A, B and C who developed complications, showing statistically significant differences between the 3 groups (P<0.05).
ConclusionsIn the treatment of split fractures of humeral greater tuberosity, arthroscopic hollow screws combined with a suture anchor, hollow screws and PHILOS can all relieve pain and restore joint function of the shoulder. However, arthroscopic hollow screws combined with a suture anchor are the most recommendable due to their advantages in minimally invasiveness and reduction in complications.
Key words:
Shoulder joint; Arthroscopy; Fracture fixation, internal; Split fracture of humeral greater tuberosity; Hollow screws; Proximal humerus internal locking system
Contributor Information
Liu Gang
Department of Joint Surgery, Hospital of Traditional Chinese Medicine, Affiliated to Southwest Medical University, Luzhou 646000, China
Research Center for Orthopedic Diseases, Hospital of Traditional Chinese Medicine, Affiliated to Southwest Medical University, Luzhou 646000, China
Clinical Base in Hospital of Traditional Chinese Medicine, Affiliated to Southwest Medical University, Guangdong Research Center of Medical 3D Printing Application Transformation Engineering Technology, Luzhou 646000, China
Luo Hong
Department of Joint Surgery, Hospital of Traditional Chinese Medicine, Affiliated to Southwest Medical University, Luzhou 646000, China
Research Center for Orthopedic Diseases, Hospital of Traditional Chinese Medicine, Affiliated to Southwest Medical University, Luzhou 646000, China
Clinical Base in Hospital of Traditional Chinese Medicine, Affiliated to Southwest Medical University, Guangdong Research Center of Medical 3D Printing Application Transformation Engineering Technology, Luzhou 646000, China
Zhang Baolu
College of Nursing, Southwest Medical University, Luzhou 646000, China
Tang Weili
Department of Joint Surgery, Hospital of Traditional Chinese Medicine, Affiliated to Southwest Medical University, Luzhou 646000, China
Research Center for Orthopedic Diseases, Hospital of Traditional Chinese Medicine, Affiliated to Southwest Medical University, Luzhou 646000, China
Clinical Base in Hospital of Traditional Chinese Medicine, Affiliated to Southwest Medical University, Guangdong Research Center of Medical 3D Printing Application Transformation Engineering Technology, Luzhou 646000, China
Liu Yang
Department of Joint Surgery, Hospital of Traditional Chinese Medicine, Affiliated to Southwest Medical University, Luzhou 646000, China
Research Center for Orthopedic Diseases, Hospital of Traditional Chinese Medicine, Affiliated to Southwest Medical University, Luzhou 646000, China
Clinical Base in Hospital of Traditional Chinese Medicine, Affiliated to Southwest Medical University, Guangdong Research Center of Medical 3D Printing Application Transformation Engineering Technology, Luzhou 646000, China
Qin Bo
Department of Joint Surgery, Hospital of Traditional Chinese Medicine, Affiliated to Southwest Medical University, Luzhou 646000, China
Research Center for Orthopedic Diseases, Hospital of Traditional Chinese Medicine, Affiliated to Southwest Medical University, Luzhou 646000, China
Clinical Base in Hospital of Traditional Chinese Medicine, Affiliated to Southwest Medical University, Guangdong Research Center of Medical 3D Printing Application Transformation Engineering Technology, Luzhou 646000, China
Deng Kai
Department of Joint Surgery, Hospital of Traditional Chinese Medicine, Affiliated to Southwest Medical University, Luzhou 646000, China
Research Center for Orthopedic Diseases, Hospital of Traditional Chinese Medicine, Affiliated to Southwest Medical University, Luzhou 646000, China
Clinical Base in Hospital of Traditional Chinese Medicine, Affiliated to Southwest Medical University, Guangdong Research Center of Medical 3D Printing Application Transformation Engineering Technology, Luzhou 646000, China
Zeng Shengqiang
Department of Joint Surgery, Hospital of Traditional Chinese Medicine, Affiliated to Southwest Medical University, Luzhou 646000, China
Research Center for Orthopedic Diseases, Hospital of Traditional Chinese Medicine, Affiliated to Southwest Medical University, Luzhou 646000, China
Clinical Base in Hospital of Traditional Chinese Medicine, Affiliated to Southwest Medical University, Guangdong Research Center of Medical 3D Printing Application Transformation Engineering Technology, Luzhou 646000, China
Bao Dingsu
Department of Joint Surgery, Hospital of Traditional Chinese Medicine, Affiliated to Southwest Medical University, Luzhou 646000, China
Research Center for Orthopedic Diseases, Hospital of Traditional Chinese Medicine, Affiliated to Southwest Medical University, Luzhou 646000, China
Clinical Base in Hospital of Traditional Chinese Medicine, Affiliated to Southwest Medical University, Guangdong Research Center of Medical 3D Printing Application Transformation Engineering Technology, Luzhou 646000, China
Fu Shijie
Department of Joint Surgery, Hospital of Traditional Chinese Medicine, Affiliated to Southwest Medical University, Luzhou 646000, China
Research Center for Orthopedic Diseases, Hospital of Traditional Chinese Medicine, Affiliated to Southwest Medical University, Luzhou 646000, China
Clinical Base in Hospital of Traditional Chinese Medicine, Affiliated to Southwest Medical University, Guangdong Research Center of Medical 3D Printing Application Transformation Engineering Technology, Luzhou 646000, China
