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* These authors contributed equally
Here, we present a protocol to utilize anatomical plates alongside rotator cuff reinforcement in a minimally invasive surgery to efficiently treat humerus greater tuberosity fractures, promising quicker healing and improved stability.
Greater tuberosity fractures of the humerus can be challenging to manage due to their complex anatomy and the potential for compromised shoulder function. We present a novel technique for treating greater tuberosity fractures utilizing specialized anatomical plates and rotator cuff reinforcement. The technique involves the use of an anatomically T-shaped plate designed specifically for the greater tuberosity region of the humerus, allowing for precise fixation and stability. Additionally, rotator cuff reinforcement is performed using sutures to enhance structural integrity and promote early mobilization. The simplified process is as follows: After administering anesthesia, a 3 cm incision is made along the lateral aspect of the shoulder to precisely expose the fracture site of the greater tuberosity. A suture of size 5 is skillfully threaded through the tough rotator cuff tendon to securely attach the proximal humerus to the anatomical plate after the greater tuberosity has been reduced. Intraoperative fluoroscopy is utilized to verify the accurate positioning of plates and screws. After ensuring everything is correct, the surgery concludes.
Greater tuberosity fractures of the humerus are a common type of upper limb fracture, often accompanied by joint pain and functional impairment1. Traditional treatment methods are associated with larger incisions and longer recovery periods.We introduce a refined treatment protocol that maximizes patient outcomes and minimizes surgical invasiveness. Stemming from a growing need for efficient fracture management, this technique's rationale is grounded in the principle of expedited patient recovery with minimal postoperative complications. In recent years, the development of minimally invasive techniques has garnered attention2. The application of specialized anatomical plates combined with rotator cuff reinforcement for fixation has become increasingly favored. The technique stands as a superior alternative to traditional methods characterized by their larger incisions and protracted recovery times. Comparative advantages of this approach, as evidenced by previous studies, include diminished tissue trauma, faster rehabilitation, and reinforced stability, crucially reducing the risks associated with anchor pull-out-an issue prevalent in traditional procedures3,4. In current literature, this technique is gaining recognition for its potential to transform the management of humeral fractures. It aligns with the current trend toward minimally invasive surgeries prioritizing functional recovery and patient quality of life. Candidates suitable for this method are those who stand to benefit from a swift return to daily activities and optimal cosmetic outcomes due to minimized scarring.
This article will provide a detailed description of the procedural steps of this technique and highlight its advantages in treating greater tuberosity fractures of the humerus5. This innovative approach offers several distinctive advantages. Firstly, the minimally invasive nature of the procedure translates to reduced tissue trauma and hastened postoperative rehabilitation. This facilitates early engagement in rehabilitative exercises, thereby promoting enhanced functional recovery. Secondly, adding rotator cuff reinforcement makes the fracture fixation more stable, which lowers the risk of anchor pull-out after surgery. Moreover, the diminished extent of postoperative trauma contributes to minimized scar formation, ultimately enhancing patients' quality of life. As technological advancements continue, the application of this minimally invasive treatment modality is poised to gain wider traction in the realm of greater tuberosity fracture management. Our study demonstrates that the utilization of specialized anatomical plates in conjunction with rotator cuff reinforcement presents a novel and effective avenue for addressing greater tuberosity fractures of the humerus. Through its amalgamation of reduced trauma, enhanced stability, and expedited recovery, this technique provides a compelling alternative for patients with these fractures, heralding a new era of optimized treatment strategies.
The inclusion criteria include (i) Diagnosis of isolated greater tuberosity fracture: Patients presenting with radiologically confirmed isolated greater tuberosity fractures suitable for open reduction and internal fixation. (ii) Age: Adult patients aged 18 and above. (iii) Symptomatic fracture: Patients experiencing functional impairment and pain due to the fracture. (iv) Bone quality: Adequate bone quality that is amenable to secure surgical fixation with screws and plates. (v) Conservative treatment failure: Patients who have not achieved satisfactory results with non-surgical treatment methods after a reasonable period. (vi) Patient consent: Willingness and ability to give informed consent for surgery and to comply with postoperative rehabilitation protocols.
The exclusion criteria include (i) Polytrauma cases: Patients with multiple injuries where the patient's overall condition contraindicates surgical intervention. (ii) Pathological fracture: Fracture resulting from primary or metastatic bone tumors. (iii) Poor bone quality: Severe osteoporosis or other metabolic bone diseases that compromise the integrity of fixation. (iv) Systemic infections or local skin infections: Presenting a risk of postoperative infection due to compromised immunity or existing infection at the surgical site. (v) Neurovascular compromise: Pre-existing neurovascular injuries at the surgical site that could be exacerbated by the procedure. (vi) Medical comorbidities: Uncontrolled diabetes, severe cardiovascular, pulmonary, or other systemic diseases that pose an unacceptable anesthetic or surgical risk. (vii) Cognitive impairment: Conditions that impede the patient's understanding and cooperation with surgical and postoperative requirements. (viii) Previous surgery or deformity: Prior surgical procedures or deformities in the affected area that may influence the current surgical approach and outcome. (ix) Patients unable to follow postoperative protocol: Lack of a support system or other socio-economic factors that prevent adherence to postoperative care and rehabilitation instructions.
Written informed consent was obtained from the patients for publication. This surgical protocol adheres to the ethical standards established by our institution's human research ethics committee.
1. Preoperative preparation and anesthetic assessment
2. Minimally invasive surgical procedure and fixation technique
3. Postoperative care and rehabilitation plan
A patient meeting the above-described inclusion criteria underwent the minimally invasive technique for treating a fracture of the humeral greater tuberosity. Preoperative three-dimensional (3D) CT reconstruction shows a fracture of the humeral greater tuberosity (Figure 1). After administrating anesthesia, a 3 cm incision along the lateral aspect of the shoulder is precisely marked (Figure 2). The surgeon incises the skin along with the marker using a scalpel a...
The incorporation of specialized anatomical plates coupled with rotator cuff reinforcement has revolutionized the management of greater tuberosity humerus fractures, offering a minimally invasive alternative that promulgates improved healing and functionality6,7,8. Critical steps in this innovative procedure include precise preoperative imaging to evaluate the fracture pattern, careful incision placement to minimize tissue damag...
The authors declare no conflicts of interest.
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Name | Company | Catalog Number | Comments |
Anesthesia monitor | Drager | USRN-0094 | N/A |
C-arm | GE | B3SS1700060 | Intraoperative fluoroscopy |
ETHIBOND Excel polyester suture size 5 | Johnson&johnson | 130705031046294 | N/A |
Fentanyl citrate injection | Renfu Pharmaceutical | 31D090113 | anesthesia drugs |
Injection of Remifentanil Hydrochloride | Renfu Pharmaceutical | 30A11011 | anesthesia drugs |
Marker pen | Deli Group Co., Ltd. | 6921734968258 | N/A |
Needle deriver | Shanghai Medical Devices Co., Ltd. Surgical Instrument Factory | J32100 | N/A |
Patient monitor | Drager | SQC19090042HA | N/A |
Povidone-iodine | Hangzhou Minsheng Pharmaceutical Co., Ltd. | 532310292 | antiseptic solution |
Propofol emulsion injection | Xi'an Libang Pharmaceutical Co., Ltd. | 12312072I | anesthesia drugs |
Proximal humerus locking compression plate(T) | WEGO | MB66G | It is used for avulision fracture of the greater tuberosity of humerus. |
Rocuronium bromide injection | Emeishan Tonghui Pharmaceutical Co., Ltd. | 23112001 | anesthesia drugs |
Surgical blade | Hangzhou Huawei Medical Supplies Co., Ltd. | 20152020713 | N/A |
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