title: Modified osteotomy for symptomatic malunion of the humeral greater tuberosity.
abstract: Here, we describe a modified osteotomy for malunion of the greater tuberosity that facilitates bone union and prevents symptom recurrence. The 3 most important features of this technique are: (1) osteotomizing the displaced fragment that includes the bed of the fracture, (2) placing figure-of-eight sutures by passing suture threads from inside the medullary cavity through osseous holes made in the metaphysis, and (3) pushing the distal end of the osteotomized fragment into the medullary cavity and fixing it in place. This procedure was performed on 10 patients who complained of clinical symptoms derived primarily from greater tuberosity malunion after fractures of various morphologies. Eight of these patients were available for follow-up examinations over 2 postoperative years. Constant score ratios comparing the repaired side to the uninjured side ranged from 82% to 100%. These results support the use of this modified osteotomy in achieving favorable bone union and in creating sufficient subacromial space to resolve most symptoms caused by these malunited proximal humeral fractures.
authors.affiliation: *Department of Orthopedic Surgery, Eiju General Hospital, Taito-Ku, Japan; †Department of Orthopedic Surgery, School of Medicine, Keio University, Shinjuku-Ku, Japan; and ‡Department of Orthopedic Surgery, Saitama National Hospital, Wakou City, Japan.
authors.forename: Kiyohisa
authors.initials: K
authors.lastname: Ogawa
authors.forename: Noboru
authors.initials: N
authors.lastname: Matsumura
authors.forename: Atsushi
authors.initials: A
authors.lastname: Yoshida
mesh_terms: D000328:Adult; D017759:Fractures, Malunited / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010027:Osteotomy / Q000379:methods*; D012784:Shoulder Fractures / Q000150:complications / Q000601:surgery* / Q000628:therapy; D013536:Suture Techniques