ObjectiveTo evaluate the technique and the effectiveness of arthroscopic fixation with percutaneous cannulated screws for acute displaced isolated greater tuberosity fractures of the proximal humerus. MethodsA retrospective analysis was made on the clinical data of 15 patients with acute displaced isolated greater tuberosity fractures of the proximal humerus, who accepted arthroscopic percutaneous cannulated screw fixation treatment between January 2010 and February 2013. There were 8 males and 7 females with an average age of 44.9 years (range, 31-66 years). Eight left shoulders and 7 right shoulders were affected. The mean interval of injury and operation was 9.9 days (range, 4-19 days). Before operation, the average range of motion (ROM) values of the affected shoulder were (74.13±17.19)° in forward flexion, (121.67±17.50)° in abduction, (T11±2)° in internal rotation, and (39.27±8.08)° in external rotation; the visual analogue scale (VAS) score was 6.46±1.30; and Costant score was 62.27±11.90. ResultsOperations were all successfully completed and incision healed by first intention in all cases. All cases were followed up 12-27 months (mean, 15 months). Postoperative X-ray films showed good reduction, alignment, and union of fracture. The average fracture healing time was 8 weeks (range, 6-13 weeks). At last follow-up, the ROM of the affected shoulder were significantly improved to (169.33±7.99)° in forward flexion, (156.67±10.47)° in abduction, (T6±2)° in internal rotation, and (71.67±7.94)° in external rotation (P<0.05); the VAS score was significantly reduced to 1.73±1.02 (t=-8.51, P=0.00); and the Costant score was significantly increased to 96.20±2.34 (t=11.50, P=0.00). No complication was found, such as neural or vascular injury, infection, shoulder joint adhesion, fixation failure, or fracture displacement. ConclusionArthroscopic fixation with percutaneous cannulated screws is a safe method to treat acute displaced isolated greater tuberosity fractures of the proximal humerus, and it has good short-term effectiveness with the advantages of little trauma and satisfactory functional recovery.
ObjectiveTo investigate the effectiveness of reversed arthroscopic subacromial decompression in the treatment of rotator cuff tears. MethodsBetween November 2012 and January 2015, 53 patients with rotator cuff tears were treated with reversed arthroscopic subacromial decompression and rotator cuff repair. Of 53 patients, 38 were male and 15 were female, with the age of 47-61 years (mean, 53.4 years). The injury was caused by falling in 36 cases and other in 17 cases without an obvious history of trauma. All patients had shoulder pain and limited shoulder movement before operation. Visual analogue scale (VAS) was 6.4±0.9, and University of California at Los Angeles (UCLA) score was 16.3±1.9. MRI showed that distal supraspinatus tear was observed in 41 cases and distal infraspinatus tear in 12 cases; partial-thickness rotator cuff tear was observed in 9 cases and full-thickness tear in 44 cases. And the tear size was from 1 to 3 cm (mean, 1.9 cm). Combined injuries included tendinitis of long head of biceps brachii in 31 cases, Bankart lesion in 5 cases, and superior labrum anterior and posterior lesion in 2 cases. ResultsIncision healed by first intention in all patients; no infection or nerve injury occurred. Forty-nine cases were followed up from 12 to 35 months (mean, 22.8 months). After operation, shoulder pain relief was achieved in 42 cases; 7 cases had anterior shoulder pain at 3 months after operation, which was relieved after symptomatic treatment. At last follow-up, VAS score was significantly decreased to 0.5±0.6 (t=40.565, P=0.000). UCLA score was significantly increased to 33.8±1.7 (t=-79.799, P=0.000). The results were excellent in 42 cases, good in 6 cases, and fair in 1 case; the excellent and good rate was 98.0%. ConclusionReversed arthroscopic subacromial decompression can avoid coracoacromial arch injury and achieve good recovery of joint function, so it can be used in rotator cuff tears procedure.
ObjectiveTo explore the clinical effect of open reduction and internal fixation with hollow screw fixation in the treatment of difficult reduction of shoulder joint dislocation combined with fracture of greater tuberosity of humerus.MethodsFrom January 2011 to March 2014, 15 patients with difficult reduction of shoulder joint dislocation combined with fracture of greater tuberosity of humerus were treated with open reduction and hollow screw fixation. There were 9 males and 6 females, aged from 45 to 77 years with an average of 63.5 years. The causes of injury included 7 cases of falls, 5 cases of high falling injury, and 3 cases of traffic accident injury. The injury-to-admission time was 2 hours to 5 days with an average of 1.5 days. The shoulder joint was the initial dislocation. The types of dislocation showed 14 cases of anterior dislocation and 1 case of posterior dislocation. There were 9 cases of simple avulsion fracture of greater tuberosity of humerus, 5 cases of comminuted fracture, 1 case of both greater tuberosity of humeru with small tuberosity of humerus fracture, and 2 cases of incomplete nerve injury; no exploration was carried out in operation.ResultsThere were 14 patients with wound healing at first intention; 1 suffered superficial infection of the wound, which healed by anti infection treatment. Fifteen cases were followed up for 6 to 18 months with an average of 12.2 months, with 1 case of shoulder joint re-dislocation 1 month after operation, and 2 cases of tuberosity of humerus defect absorption. One year after operation, the shoulder joint function were evaluated according to Neer Scoring System, and the results were excellent in 9 cases, good in 3 cases, fair in 2 cases, and poor in 1 case, with the excellent and good rate of 80.0%.ConclusionThe curative effect of open reduction and internal fixation with hollow screw fixation on difficult reduction of shoulder joint dislocation combined with fracture of greater tuberosity of humerus is remarkable, which can obtain satisfactory shoulder joint function.
ObjectiveTo observe effectivness and safeness of self-made dentation hook plate associated with hot-air balloon technique in treating Mutch Ⅰ or Ⅱ type isolated greater tuberosity fractures of humerus.MethodsBetween January 2016 and December 2018, 15 patients with Mutch Ⅰ or Ⅱ type greater tuberosity fractures were treated with self-made dentation hook plate associated with hot-air balloon technique. There were 9 males and 6 females with an average age of 45.1 years (range, 29-62 years). The injury causes included falling injury in 9 patients and traffic accident injury in 6 patients. According to Mutch classification, 4 cases were MutchⅠ type and 11 cases were Mutch Ⅱ type. There were 7 cases with anterior dislocation of shoulder. The time from injury to operation was 2-10 days (mean, 4.5 days).ResultsAll 15 patients were followed up 8-16 months, with an average of 13.5 months. There was no infection of incision, loss of reduction of fracture block, delayed union or nonunion. The average time of fracture union was 6.5 months (range, 4-8 months). One patient had axillary paralysis at 1 day after operation, and was treated with nutritional nerve therapy, the symptoms disappeared after 2.5 months. Three patients had slight subacromial impingement. After fracture healing, the hook plate was taken out in advance, and the pain and abnormal noise disappeared during shoulder abduction. At last follow-up, Costant-Murley score used to evaluate shoulder joint function was 88-100, with an average of 96.8; 8 cases were excellent, 7 cases were good, and the excellent and good rate was 100%. The internal fixator was removed after 8-16 months after the secondary operation with no re-fracture occurred.ConclusionThe self-made dentation hook plate associated with hot-air balloon technique is a safe and reliable method for the treatment of Mutch Ⅰ or Ⅱ type isolated greater tuberosity fracture of humerus.