Open reduction and internal fixation for old displaced fractures of humeral greater tuberosity / 中华创伤骨科杂志

ABSTRACT

Objective:To investigate the operative treatments of old displaced fractures of humeral greater tuberosity and their related factors.Methods:A retrospective study was conducted of the 16 patients who had received operative treatment at Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital for old displaced fractures of humeral greater tuberosity from November 2010 to March 2019 and whose complete follow-up data were available. They were 9 males and 7 females with an average age of 61 years(from 40 to 77 years). The original injury was accompanied by shoulder dislocation in 12 cases; the original displaced fracture of humeral greater tuberosity was not surgically treated in time in 8 cases; the primary surgical treatment did not lead to effective fracture reduction in 4 cases; the fracture of humeral greater tuberosity was displaced again after surgical treatment in 4 cases. Anterior displacement was observed in 2 cases, posterior displacement in 3 cases and superior displacement in 11 cases. The duration between the onset of displacement and the last operation averaged 5 months, and the displacement distance 16.5 mm. The Constant-Murley and visual analogue scale(VAS) scores were compared between preoperation and 6 months postoperation.Results:This group of patients obtained a mean follow-up of 55 months(from 16 to 118 months). Anatomical reduction of the greater tuberosity was achieved in 15 cases, leading to uneventful union. Mal-reduction occurred in one patient whose greater tuberosity was found displaced superiorly again by follow-up. For the 16 patients, the Constant-Murley absolute value scores were 37.0±11.7 and 91.0±9.9, and the flexion elevation ranges 33.0°±26.7° and 144.0°±38.5°, respectively for preoperation and 6 months postoperation, showing significant improvements between preoperation and 6 months postoperation( P<0.05). The VAS scores were 0.7±1.3 at 6 months postoperation, significantly improved than the preoperative value 4.5±1.0 ( P<0.05). Postoperatively, good shoulder function scores were not obtained by one patient who could still manage to fulfill daily life tasks. Conclusion:Open reduction and internal fixation can result in satisfactory functional outcomes in the treatment of old displaced fractures of the humeral greater tuberosity, depending on different features of fracture displacement.