title: Arthroscopic-assisted plate fixation for displaced large-sized comminuted greater tuberosity fractures of proximal humerus: a novel surgical technique.
abstract: OBJECTIVE
  The purpose of the present study was to describe the use of a novel hybrid surgical technique-arthroscopic-assisted plate fixation-and evaluate its clinical and anatomical outcomes in the management of large, displaced greater tuberosity (GT) fractures with comminution.
  
  
  METHODS
  From 2009 to 2011, this novel technique was performed in 11 patients [2 men and 9 women; median age, 64 years (range 41-83 years)] with large, comminuted GT fractures, with fragment displacements of >5 mm. The preoperative mean posterior and superior migration of the fractured fragment, as measured on computed tomography (CT), was 19.5 and 5.5 mm, respectively. Two patients had shoulder fracture-dislocation, and three had associated undisplaced surgical neck fracture. The mean duration between injury and surgery was 4 days. The mean follow-up duration was 26 months.
  
  
  RESULTS
  At the final follow-up, the mean postoperative ASES, UCLA and SST scores were 84, 29, and 8, respectively. The mean range of motion was as follows: forward flexion, 138°; abduction, 135°; external rotation at the side, 19°; and internal rotation, up to the L2 level. The mean posterior and superior displacements of fracture fragments on postoperative CT scan [0.7 ± 0.8 mm (range 0-2.1 mm) and 2.8 ± 0.5 mm (range 3.4-5.3 mm), respectively] were significantly improved (p < 0.05). On arthroscopy, a partial articular-side supraspinatus tendon avulsion lesion was identified in 10 of 11 patients (91 %), and 1 of these patients had a partial tear of the biceps and 1 had a partial subscapularis tear, respectively (9 %). Intraoperatively, 1 anchor pullout and 1 anchor protrusion through the humeral head were noted and corrected. Postoperatively, the loss of reduction in the fracture fragment was noted in 1 patient at 4 weeks, after corrective reduction and fixation surgery.
  
  
  CONCLUSIONS
  The novel arthroscopic-assisted anatomical plate fixation technique was found to be effective in reducing large-sized, displaced, comminuted GT fractures and in allowing concurrent management of intra-articular pathologies and early functional rehabilitation. Compared with the conventional plate fixation or arthroscopic suture anchor fixation technique, arthroscopic-assisted plate fixation enabled accurate restoration of the medial footprint of the GT fracture and provided an effective buttress to the large-sized GT fracture fragments.
  
  
  METHODS
  Retrospective clinical study, Level IV.
authors.affiliation: Department of Orthopedic Surgery, Daejon St. Mary's Hospital, The Catholic University of Korea, 520-2, Deahung-Dong, Joong-Ku, Daejeon, 302-803, Korea.
authors.forename: Sang-Eun
authors.initials: SE
authors.lastname: Park
authors.affiliation: Department of Orthopedic Surgery, Daejon St. Mary's Hospital, The Catholic University of Korea, 520-2, Deahung-Dong, Joong-Ku, Daejeon, 302-803, Korea.
authors.forename: Jae-Jung
authors.initials: JJ
authors.lastname: Jeong
authors.affiliation: Department of Orthopedic Surgery, Daejon St. Mary's Hospital, The Catholic University of Korea, 520-2, Deahung-Dong, Joong-Ku, Daejeon, 302-803, Korea.
authors.forename: Karnav
authors.initials: K
authors.lastname: Panchal
authors.affiliation: Department of Orthopedic Surgery, Daejon St. Mary's Hospital, The Catholic University of Korea, 520-2, Deahung-Dong, Joong-Ku, Daejeon, 302-803, Korea.
authors.forename: Jong-Yun
authors.initials: JY
authors.lastname: Lee
authors.affiliation: Department of Orthopedic Surgery, Daejon St. Mary's Hospital, The Catholic University of Korea, 520-2, Deahung-Dong, Joong-Ku, Daejeon, 302-803, Korea.
authors.forename: Hyung-Ki
authors.initials: HK
authors.lastname: Min
authors.affiliation: Department of Orthopedic Surgery, Daejon St. Mary's Hospital, The Catholic University of Korea, 520-2, Deahung-Dong, Joong-Ku, Daejeon, 302-803, Korea. junwoo0220@yahoo.co.kr.
authors.forename: Jong-Hun
authors.initials: JH
authors.lastname: Ji
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001182:Arthroscopy / Q000379:methods*; D001860:Bone Plates; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D018460:Fractures, Comminuted / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012189:Retrospective Studies; D012784:Shoulder Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D053441:Suture Anchors; D013536:Suture Techniques; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Arthroscopic-assisted plate fixation; Displaced large-sized comminuted greater tuberosity fractures