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Open Access 01-12-2017 | Research article

Single versus double row suture anchor fixation for greater tuberosity fractures – a biomechanical study

Authors: Gernot Seppel, Tim Saier, Frank Martetschläger, Johannes E. Plath, Alberto Guevara-Alvarez, Julia Henschel, Martin Winkler, Peter Augat, Andreas B. Imhoff, Stefan Buchmann

Published in: BMC Musculoskeletal Disorders | Issue 1/2017

Abstract

Background

Fractures of the humeral greater tuberosity (GT) are a frequent injury progressively treated with arthroscopic suture anchor repair. Yet, no biomechanical study has been performed comparing fixation strength of arthroscopic single- (SR) vs. double row (DR) fixation.

Methods

Standardized fractures of the greater tuberosity were created in 12 fresh frozen proximal humeri. After random assignation to the SR or DR group the fixed humeri were tested applying cyclic loading to the supraspinatus and infraspinatus tendon. Load to failure and fragment displacement were assessed by means of an electrodynamic material testing machine using an optical tracking system.

Results

Load to failure values were higher in the DR group (649 N; ±176) than in the SR group (490 N; ±145) however without statistical significance (p = .12). In greater tuberosity displacement of 3–5 mm surgical treatment is recommended. The fixing constructs in this study did not reach displacement landmarks of 3 or 5 mm before construct failure as shown in previous studies. Thus the applied traction force (N) at 1 mm displacement was analyzed. In the SR group the load at 1 mm displacement was 277 N; ±46 compared to 260 N; ±62 in the DR group (p = .65).

Conclusion

The results suggest that both techniques are viable options for refixation of greater tuberosity fractures.

Level of Evidence: Laboratory study.

Bahrs C, Lingenfelter E, Fischer F, Walters EM, Schnabel M. Mechanism of injury and morphology of the greater tuberosity fracture. Journal of shoulder and elbow surgery/American Shoulder and Elbow Surgeons [et al.]. 2006;15:140–7. https://doi.org/10.1016/j.jse.2005.07.004.CrossRef

Bono CM, Renard R, Levine RG, Levy AS. Effect of displacement of fractures of the greater tuberosity on the mechanics of the shoulder. The Journal of bone and joint surgery British volume. 2001;83:1056–62.CrossRefPubMed

Braunstein V, Wiedemann E, Plitz W, Muensterer OJ, Mutschler W, Hinterwimmer S. Operative treatment of greater tuberosity fractures of the humerus--a biomechanical analysis. Clin Biomech. 2007;22:652–7. https://doi.org/10.1016/j.clinbiomech.2007.03.002.CrossRef

Brunner UH. Humeruskopffraktur. In: Habermayer P, editor. Schulterchirurgie. Urban und Fischer, München, pp; 2002. p. 404–29.

Burkhart SS. A stepwise approach to arthroscopic rotator cuff repair based on biomechanical principles. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association. 2000;16:82–90.CrossRef

Cadet ER, Ahmad CS (2007) Arthroscopic reduction and suture anchor fixation for a displaced greater tuberosity fracture: a case report. Journal of shoulder and elbow surgery/American Shoulder and Elbow Surgeons [et al.] 16:e6–e9. doi:https://doi.org/10.1016/j.jse.2006.08.010.

Clark JM, Harryman DT, 2nd (1992) Tendons, ligaments, and capsule of the rotator cuff. Gross and microscopic anatomy. The Journal of bone and joint surgery American volume 74:713–725.

Flatow EL, Cuomo F, Maday MG, Miller SR, McIlveen SJ, Bigliani LU. Open reduction and internal fixation of two-part displaced fractures of the greater tuberosity of the proximal part of the humerus. The Journal of bone and joint surgery American. 1991;73:1213–8.CrossRef

Gerber C, Warner JJP (1997) Alternatives to hemiarthroplasty for complex proximal-humerus fractures. In: Warner JJP, Iannotti JP, Gerber C (eds) Complex and revision problems in shoulder surgery. Lippincott-raven, Philadelphia, pp pp. 215–243.

10.

Green A, Izzi J Jr. Isolated fractures of the greater tuberosity of the proximal humerus. Journal of shoulder and elbow surgery/American Shoulder and Elbow Surgeons [et al]. 2003;12:641–9. https://doi.org/10.1016/S1058274602868112.CrossRef

11.

Ishak C, Sahajpal D, Chiang A, Atallah W, Kummer F, Jazrawi LM. Fixation of greater tuberosity fractures: a biomechanical comparison of three techniques. Bulletin. 2006;63:98–9.

12.

Ji JH, Shafi M, Song IS, Kim YY, McFarland EG, Moon CY. Arthroscopic fixation technique for comminuted, displaced greater tuberosity fracture. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association. 2010;26:600–9. https://doi.org/10.1016/j.arthro.2009.09.011.CrossRef

13.

Keener JD, Parsons BO, Flatow EL, Rogers K, Williams GR, Galatz LM. Outcomes after percutaneous reduction and fixation of proximal humeral fractures. Journal of shoulder and elbow surgery/American Shoulder and Elbow Surgeons [et al.]. 2007;16:330–8. https://doi.org/10.1016/j.jse.2006.09.006.CrossRef

14.

Kim YS, Lee BG, Rhee YG, Lee CH. Arthroscopic reduction and internal fixation for displaced anterior glenoid rim and greater tuberosity fractures. Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association. 2014;19:497–501. https://doi.org/10.1007/s00776-012-0309-6.CrossRef

15.

Kristiansen B, Angermann P, Larsen TK. Functional results following fractures of the proximal humerus. A controlled clinical study comparing two periods of immobilization. Arch Orthop Trauma Surg. 1989;108:339–41.CrossRefPubMed

16.

Lee SU, Jeong C, Park IJ. Arthroscopic fixation of displaced greater tuberosity fracture of the proximal humerus. Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA. 2012;20:378–80. https://doi.org/10.1007/s00167-011-1748-x.CrossRef

17.

Lin CL, Hong CK, Jou IM, Lin CJ, FC S, WR S. Suture anchor versus screw fixation for greater tuberosity fractures of the humerus--a biomechanical study. Journal of orthopaedic research: official publication of the Orthopaedic Research Society. 2012;30:423–8. https://doi.org/10.1002/jor.21530.CrossRef

18.

Lind T, Kroner K, Jensen J. The epidemiology of fractures of the proximal humerus. Arch Orthop Trauma Surg. 1989;108:285–7.CrossRefPubMed

19.

Lumsdaine W, Smith A, Walker RG, Benz D, Mohammed KD, Stewart F. Morphology of the humeral insertion of the supraspinatus and infraspinatus tendons: application to rotator cuff repair. Clin Anat. 2015;28:767–73. https://doi.org/10.1002/ca.22548.CrossRefPubMed

20.

Maman E, Dolkart O, Chechik O, Amar E, Rak O, Rath E, Mozes G. Arthroscopic findings of coexisting lesions with greater tuberosity fractures. Orthopedics. 2014;37:e272–7. https://doi.org/10.3928/01477447-20140225-60.CrossRefPubMed

21.

Minagawa H, Itoi E, Konno N, Kido T, Sano A, Urayama M, Sato K. Humeral attachment of the supraspinatus and infraspinatus tendons: an anatomic study. Arthroscopy : the journal of arthroscopic & related surgery: official publication of the Arthroscopy Association of North America and the International Arthroscopy Association. 1998;14:302–6.CrossRef

22.

Mochizuki T, Sugaya H, Uomizu M, Maeda K, Matsuki K, Sekiya I, Muneta T, Akita K. Humeral insertion of the supraspinatus and infraspinatus. New anatomical findings regarding the footprint of the rotator cuff. The Journal of bone and joint surgery American. 2008;90:962–9. https://doi.org/10.2106/JBJS.G.00427.CrossRef

23.

Park SE, Jeong JJ, Panchal K, Lee JY, Min HK, Ji JH. Arthroscopic-assisted plate fixation for displaced large-sized comminuted greater tuberosity fractures of proximal humerus: a novel surgical technique. Knee surgery, sports traumatology, arthroscopy: official journal of the ESSKA. 2015; https://doi.org/10.1007/s00167-015-3805-3.

24.

Park SE, Ji JH, Shafi M, Jung JJ, Gil HJ, Lee HH. Arthroscopic management of occult greater tuberosity fracture of the shoulder. European journal of orthopaedic surgery & traumatology: orthopedie traumatologie. 2014;24:475–82. https://doi.org/10.1007/s00590-013-1212-3.CrossRef

25.

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. Bulletin. 1997;56:171–6.

26.

Platzer P, Thalhammer G, Oberleitner G, Kutscha-Lissberg F, Wieland T, Vecsei V, Gaebler C. Displaced fractures of the greater tuberosity: a comparison of operative and nonoperative treatment. J Trauma. 2008;65:843–8. https://doi.org/10.1097/01.ta.0000233710.42698.3f.CrossRefPubMed

27.

Resch H, Hubner C, Schwaiger R. Minimally invasive reduction and osteosynthesis of articular fractures of the humeral head. Injury. 2001;32(Suppl 1):SA25–32.CrossRefPubMed

28.

Scheibel M, Martinek V, Imhoff AB. Arthroscopic reconstruction of an isolated avulsion fracture of the lesser tuberosity. Arthroscopy : the journal of arthroscopic & related surgery: official publication of the Arthroscopy Association of North America and the International Arthroscopy Association. 2005;21:487–94. https://doi.org/10.1016/j.arthro.2004.11.012.CrossRef

29.

Taverna E, Sansone V, Battistella F. Arthroscopic treatment for greater tuberosity fractures: rationale and surgical technique. Arthroscopy : the journal of arthroscopic & related surgery: official publication of the Arthroscopy Association of North America and the International Arthroscopy Association. 2004;20:e53–7.CrossRef

30.

Tuoheti Y, Itoi E, Yamamoto N, Seki N, Abe H, Minagawa H, Okada K, Shimada Y. Contact area, contact pressure, and pressure patterns of the tendon-bone interface after rotator cuff repair. Am J Sports Med. 2005;33:1869–74. https://doi.org/10.1177/0363546505278256.CrossRefPubMed

31.

Williams GR Jr, Wong KL. Two-part and three-part fractures: open reduction and internal fixation versus closed reduction and percutaneous pinning. The Orthopedic clinics of North America. 2000;31:1–21.CrossRefPubMed

Title: Single versus double row suture anchor fixation for greater tuberosity fractures – a biomechanical study
Authors: Gernot Seppel
Tim Saier
Frank Martetschläger
Johannes E. Plath
Alberto Guevara-Alvarez
Julia Henschel
Martin Winkler
Peter Augat
Andreas B. Imhoff
Stefan Buchmann
Publication date: 01-12-2017
Publisher: BioMed Central
Published in: BMC Musculoskeletal Disorders / Issue 1/2017
Electronic ISSN: 1471-2474
DOI: https://doi.org/10.1186/s12891-017-1868-7

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Single versus double row suture anchor fixation for greater tuberosity fractures – a biomechanical study

Abstract

Background

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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