• Arthroscopy
• Instability
• Rotator cuff
• Shoulder
• Trauma

• arthroscopic reduction
• double‐row suture bridge
• greater tuberosity fracture
• large‐sized

• Humans
• Retrospective Studies
• Arthroscopy/methods
• Male
• Female
• Middle Aged
• Adult
• Shoulder Fractures/surgery
• Shoulder Fractures/diagnostic imaging
• Fracture Fixation, Internal/methods
• Treatment Outcome
• Suture Techniques
• Range of Motion, Articular
• Radiography
• Aged
• Follow-Up Studies

• UUH-2022-04 Ulsan University Hospital Research Grant

• Alzheimers
• Greater tuberosity fracture
• Irreducible anterior shoulder dislocation
• Long head of biceps
• Open reduction

• Fixation strategies
• Fracture dislocation
• Greater tuberosity
• Iatrogenic fracture
• Proximal humerus fracture
• Surgical fixation

• Humans
• Rotator Cuff Injuries/surgery
• Arthroscopy/methods
• Rotator Cuff/surgery
• Treatment Outcome

• Hill-Sachs
• Mechanism
• Proximal humerus fracture
• Shoulder biomechanics
• Shoulder dislocation

• calcaneal anatomical locking plate
• humeral greater tuberosity
• proximal humeral internal locking system (PHILOS)
• split fractures
• surgery

• Clinical characteristics
• Epidemiology
• Injury incidence
• Rugby union

• Humans
• Male
• Prospective Studies
• Incidence
• Rugby
• Universities
• Athletic Injuries/epidemiology
• Athletic Injuries/prevention & control
• Students

• Critical shoulder angle
• Glenoid inclination
• Greater tuberosity fractures
• Scapula morphology
• Shoulder dislocation

• Displacement
• Fracture morphology
• Glenohumeral dislocation
• Greater tuberosity
• Radiological outcome

• Humeral greater tuberosity fracture
• biomechanics
• hook plate
• screw fixation

• Biomechanical simulation
• Fracture configuration
• Fracture simulation
• Proximal humerus fracture
• Rotator cuff
• Surgical training

• Anchor
• Greater tuberosity fracture
• Minimally invasive
• Open reduction
• Suture bridge

Split fractures of the humeral greater tuberosity (HGT) are common injuries. Although there are numerous surgical treatments for these fractures, no classification system combining clinical and biomechanical characteristics has been presented to guide the choice of fixation method.

We created a standardised fracture of the HGT in 24 formalin-fixed cadavers. Six were left as single-fragment fractures (Group A), six were further prepared to create single-fragment with medium size full-thickness rotator cuff tear (FT-RCT) fractures (Group B), six were cut to create multi-fragment fractures (Group C), and six were cut to create multi-fragment with FT-RCT fractures (Group D). Each specimen was fixed with a shortened proximal humeral internal locking system (PHILOS) plate. The fixed fractures were subjected to load and load-to-failure tests and the differences between groups analysed.

The mean load-to-failure values were significantly different between groups (Group A, 446.83 ± 38.98 N; Group B, 384.17 ± 36.15 N; Group C, 317.17 ± 23.32 N and Group D, 266.83 ± 37.65 N, P < 0.05). The load-to-failure values for fractures with a greater tuberosity displacement of 10 mm were significantly different between each group (Group A, 194.00 ± 29.23 N; Group B, 157.00 ± 29.97 N; Group C, 109.00 ± 17.64 N and Group D, 79.67.83 ± 15.50 N; P < 0.05). These findings indicate that fractures with a displacement of 10 mm have different characteristics and should be considered separately from other HGT fractures when deciding surgical treatment.

Biomechanical classification of split fractures of the HGT is a reliable method of categorising these fractures in order to decide surgical treatment. Our findings and proposed system will be a useful to guide the choice of surgical technique for the treatment of fractures of the HGT.

• Biomechanical classification
• Humeral greater tuberosity
• Rotator cuff tear
• Split fracture
• Surgical technique

• Complications
• Isolated greater tuberosity fractures
• Outcome measures
• Surgical fixation
• Systematic review

• Apophyseal injury
• Athletic injuries
• Avulsion fractures
• Cumulative trauma disorders
• Diagnosis
• Therapeutics

• Inje University

It is assumed that dorsocranial displacement of the greater tuberosity in humeral head fractures is caused by rotator cuff traction. The purpose of this study was to investigate the association between rotator cuff status and displacement characteristics of the greater tuberosity in four-part humeral head fractures. Computed tomography scans of 121 patients with Neer type 4 fractures were analyzed. Fatty infiltration of the supra- and infraspinatus muscles was classified according to Goutallier. Position determination of the greater tuberosity fragment was performed in both coronary and axial planes to assess the extent of dorsocranial displacement. Considering non-varus displaced fractures, the extent of the dorsocranial displacement was significantly higher in patients with mostly inconspicuous posterosuperior rotator cuff status compared to advanced fatty degenerated cuffs (cranial displacement: Goutallier 0–1: 6.4 mm ± 4.6 mm vs. Goutallier 2–4: 4.2 mm ± 3.5 mm, p = 0.020; dorsal displacement: Goutallier 0–1: 28.4° ± 32.3° vs. Goutallier 2–4: 13.1° ± 16.1°, p = 0.010). In varus displaced humeral head fractures, no correlation between the displacement of the greater tuberosity and the condition of the posterosuperior rotator cuff could be detected (p ≥ 0.05). The commonly accepted theory of greater tuberosity displacement in humeral head fractures by rotator cuff traction cannot be applied to all fracture types.

• fatty degeneration
• greater tuberosity
• humeral head fracture
• rotator cuff

The best treatment for isolated greater tuberosity (GT) fractures is still controversial. Although previous studies have suggested surgical options, they are either unable to provide firm fixation or present with a variety of complications.

We retrospectively studied the records of patients with isolated GT fractures who underwent open reduction and internal fixation using a 3.5-mm locking hook plate between January 2016 and January 2018. The surgical indication was an at least 5-mm displacement of the GT as observed in either simple radiography or three-dimensional computed tomography. Clinical outcomes were assessed using the following five parameters shortly before implant removal and at the final follow-up: visual analog scale (VAS) pain score, American Shoulder and Elbow Surgeons (ASES) score, Shoulder Rating Scale of the University of California, Los Angeles (UCLA), Constant-Murley score, and range of motion.

Twenty-one patients with a mean age of 64 years were included. Bone union was achieved within 12–20 weeks of the first surgery in all patients. Implant removal was performed between 13 and 22 weeks after surgery. At the final follow-up, the mean VAS pain score, forward flexion, abduction, external rotation, internal rotation, ASES score, UCLA score, and Constant-Murley score were significantly better when compared to outcomes shortly before implant removal (p < 0.001, p < 0.001, p < 0.001, p = 0.008, p = 0.003, p < 0.001, p < 0.001, and p < 0.001, respectively).

The 3.5-mm locking hook plate provided sufficient stability and led to satisfactory clinical and radiological outcomes for isolated GT fractures. However, the hook plate may irritate the rotator cuff, and postoperative stiffness may be inevitable. Therefore, second surgery for implant removal is necessary after bone union is achieved.

• Greater tuberosity fracture
• Hook plate
• Olecranon
• Proximal humerus
• Rotator cuff

The purpose of the study is to describe the functional and structural outcomes of the arthroscopic 4-strand, knotless, double-row construct with suture tapes for the surgical treatment of displaced and/or comminuted greater tuberosity fractures of the humerus.

Patients were enrolled between December 2012 and January 2018. The main inclusion criteria were a comminuted and/or displaced tuberosity fracture with a displacement of at least 5 mm in any plane fixed under arthroscopy using a 4-strand, knotless, double-row construct. The technique involves reducing the displaced fragment with 2 medially placed, transtendinous anchors and compressing the greater tuberosity using the tapes from these medial anchors in 2 laterally placed anchors. The exclusion criteria were a fracture that was more than 10 days old at the time of surgery or a history of shoulder surgery and 3- or 4-part fractures. The postoperative rehabilitation protocol was similar for all patients. Constant scores, Quick Dash, return to work and sport, and complications were reported after a minimum follow-up period of 24 months. Bone healing was systematically evaluated on standardized radiographs, including lateral scapula view and anteroposterior views.

Twenty-one patients were enrolled in this study. One patient did not complete the follow-up examination period and thus was excluded, leaving 20 patients in this study. At a median (SD) follow-up of 32 (9) months, the median (SD) Constant score was 94.7 (7.3) points, the median (SD) Quick Dash was 1.7 (4) points, and median (SD) visual analog scale score was 0.5 (1.4). All patients returned to previous work and sport level. No malunions or nonunions were seen. One conversion to open surgery was required for failure of the lateral row during surgery in a 62-year-old woman with osteopenic bone. Two patients experienced complex regional pain syndrome in the postoperative period that resolved after nonoperative treatment.

In this series, the use of arthroscopy combined with the biomechanical properties of knotless double-row constructs contributed to postoperative satisfactory functional results and healing of greater tuberosity fracture. In addition, range of motion was early, and no hardware removal was required. However, care should be taken with osteopenic bone where anchorage can fail.

Level IV, case series.

• Dislocation
• Fracture
• Shoulder
• Tuberosity

• Cuff tear arthropathy
• Fracture morphology
• Fracture pattern
• Proximal humeral fracture

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Bankart Lesions/diagnostic imaging
• Female
• Humans
• Male
• Middle Aged
• Radiography/methods
• Reproducibility of Results
• Retrospective Studies
• Sensitivity and Specificity
• Shoulder/diagnostic imaging
• Young Adult

To gain a better understanding of the traumatic mechanism and to develop appropriate treatment for dislocation of the shoulder joint with an ipsilateral humeral shaft fracture.

This was an observational and descriptive study. Nine patients with traumatic shoulder dislocations associated with ipsilateral humeral shaft fractures who visited the emergency room and received treatment from January 2012 to June 2018 were retrospectively analyzed. CT with three‐dimensional reconstruction was performed to provide precise anatomical information of the fractures. The traumatic event and the type of fracture of the humeral shaft were analyzed to help determine the trauma mechanism. Closed reduction of the dislocation was attempted at once under intravenous anesthesia. One patient died the following day due to unrelated causes. All humeral shaft fractures of the eight patients received internal fixation, and then reduction of the dislocation was performed again if previous attempts failed. The affected limb was immobilized in a sling for 3 weeks postoperatively, and then active and passive movement was encouraged. Patients were evaluated based on clinical and radiographic examinations, shoulder joint range of motion, Constant–Murley score, and subjective shoulder value.

Four cases in the present study could not give a clear description of the traumatic procedure. The other five patients suffered a second strike on their upper arms when they were hurt, with low mobility and high pain in the shoulder region. Seven cases were simple fractures and two were wedge fractures. According to the AO/OTA classification system, four cases were type 12‐A2, three were type 12‐A3, and two were type 12‐B2. Six patients successfully obtained closed manipulative reduction of the shoulder dislocation in the acute stage. The follow‐up time ranged from 18 to 31 months. No deep wound infections were encountered. All fractures healed uneventfully. The union time ranged from 4 to 6 months. At the final follow‐up, shoulder range‐of‐motion values were found to range from 140° to 170° forward flexion, 30° to 40° extension, 40° to 45° adduction, 150° to 170° abduction, 50° to 60° internal rotation, and 50° to 60° external rotation; no recurrent instability of the shoulder joint occurred; the Constant–Murley score was 89.5 ± 3.7 points (range: 84–94 points); the subjective shoulder value was 89.4% ± 6.3% (range: 75%–95%).

Shoulder dislocation most likely occurs first with an axial force or a direct posteroanterior force and a subsequent force results in the shaft fracture. For patients with mid‐distal humerus fractures, closed manipulative reduction of the joint is usually effective. After success of closed reduction, surgery for the humeral shaft fracture is advocated to ensure stability and to make patient nursing convenient. In cases with fractures in the proximal third of the humeral shaft, fixation is suggested beforehand to help reduce the shoulder dislocation.

• Case series
• Functional outcome
• Humeral shaft fracture
• Shoulder dislocation
• Surgery

Based on the morphological characteristics of glenoid and greater tuberosity (GT) fractures and the relationship between them, we explored the injury mechanism of acute anterior shoulder dislocation associated with glenoid and GT fractures.

From December 2013 to December 2019, we retrospectively reviewed the clinical data of patients who were diagnosed with acute anterior shoulder dislocation associated with glenoid and GT fractures in our hospital. According to the fracture site, a glenoid fracture group and a greater tuberosity fracture (GT) group were established, and the morphological characteristics of both glenoid and GT fractures were measured and statistically analyzed.

A total of 41 patients (43 shoulders) met the inclusion criteria (39 unilateral shoulders and 2 bilateral shoulders). The mean age was 50.21 years (range, 22–71 years). A total of 27 shoulder injuries (62.8%) were split GT fractures and 33 shoulder injuries (76.7%) were combined with rotator cuff tears. The mean size of glenoid fragments was 30.16% and the mean displacement was 8.85 mm. The mean size of GT fragments was 28.43 mm. The mean superoinferior and anteroposterior displacements of the GT fragment were 6.77 mm and 4.96 mm, respectively. There was a negative correlation between the size of glenoid and GT fracture fragments (r = −0.64, P < 0.05). The glenoid fragments in the Ideberg type Ia glenoid fracture group were smaller than those in the Ideberg type II glenoid fracture group (28.41% and 40.95%, respectively), while the size of GT fragments in the type Ia group were larger than those in the type II group (29.77 mm and 20.21 mm, respectively) (P < 0.05). The GT fragments in the split GT fracture group were larger than those in the avulsion or depression GT fracture group (33.69 mm, 19.07 mm and 21.12 mm, respectively), while the size of glenoid fragments in the split GT fracture group were smaller than those in the avulsion or depression GT fracture group (23.57%, 41.37%, and 43.42%, respectively) (P < 0.05). As for the displacement direction of GT fragments, depression fractures were mainly inferior displacements, avulsion fractures were mainly anterosuperior displacements, while split fractures were mainly posteroinferior displacements (P < 0.05). Multiple regression analysis suggested that the type and the fragment size of GT fractures have a significant influence on the size of glenoid fragments.

Acute anterior shoulder dislocations associated with glenoid and GT fractures are often combined with rotator cuff tears. There is a negative correlation between the size of glenoid and GT fragments, and split GT fractures are most common. Such injuries are highly correlated to the relative spatial location between the GT and the glenoid when the shoulder dislocates.

• Anterior shoulder dislocation
• Fracture morphology
• Glenoid fracture
• Greater tuberosity fracture
• Injury mechanism

• arthroscopic treatment
• greater tuberosity fracture
• proximal humerus

• biomechanical modelling
• fracture patterns
• proximal humeral fracture

• Sir Siegmund Warburg's Voluntary Settlement Fund

• Greater tuberosity fractures
• Risk factor
• Secondary displacement
• Shoulder dislocation

• Aged
• Aged, 80 and over
• Bone Plates
• Female
• Fracture Fixation, Internal/methods
• Humans
• Humeral Head
• Male
• Middle Aged
• Retrospective Studies
• Shoulder Fractures/surgery
• Visual Analog Scale

• Proximal humerus degloving fracture
• fracture classification
• internal fixation

• Avulsion fracture
• Greater tuberosity fracture
• Imaging evaluation
• Isolated fracture
• Proximal humerus fracture

• Arthroscopy
• Glenoid cavity
• Rotator cuff
• Scapula
• Shoulder fractures

• Arthroscopic
• Double row fixation
• Greater tuberosity fracture
• Single-row
• Suture anchor

• Hill-Sachs lesion
• arthroscopy
• bony Bankart lesion
• glenoid fracture
• shoulder instability

Failure of closed manipulative reduction of an acute anterior shoulder dislocation is seldom reported in the literature and is usually due to structural blocks such as soft tissue entrapment (biceps, subscapularis, labrum), bony fragments (glenoid, greater tuberosity) and severe head impaction (Hill-Sachs lesion).

We present a case of an irreducible anterior shoulder dislocation in a 57-year-old male patient after a road-traffic accident. He had severe impaction of the head underneath glenoid rim and associated fracture of the greater tuberosity. Closed reduction performed in the emergency room under sedation and later at the theatre under general anaesthesia was unsuccessful. Open reduction using the dectopectoral approach revealed that the reason for obstruction was the posterolateral entrapment of the biceps tendon between the humeral head and the tuberosity fragment. Reduction was achieved after subscapularis tenotomy and opening of the joint; the tuberosity fragment was fixed with transosseous sutures and the long head of the biceps tendon was tenodesized. The patient had an uneventful postoperative recovery and at his last follow up, 12 months postoperatively, he had a stable joint, full range of motion and a Constant score of 90.

A comprehensive literature review revealed 22 similar reports affecting a total of 30 patients. Interposition of the LHBT alone or in combination with greater tuberosity fracture was the most common obstacle to reduction, followed by subscapularis tendon interposition and other less common reasons. Early surgical intervention with open reduction and confrontation of associated injuries is mandatory for a successful outcome.

• Anterior
• Greater tuberosity fracture
• Irreducible
• Long head of biceps
• Open reduction
• Shoulder dislocation

• Arthroscopic-assisted plate fixation
• Displaced large-sized comminuted greater tuberosity fractures

• Arthroscopy
• Associated injuries
• Greater tuberosity
• Shoulder dislocation
• Shoulder fracture

The financial cost of using human tissues in biomedical testing and surgical reconstruction is predicted to increase at a rate that is disproportionately greater than other materials used in biomechanical testing. Our first hypothesis is that cadaveric proximal humeri that had undergone monotonic failure testing of simulated rotator cuff repairs would not differ in ultimate fracture loads or in energy absorbed to fracture when compared to controls (i.e., bones without cuff repairs). Our second hypothesis is that there can be substantial cost savings if these cadaveric proximal humeri, with simulated cuff repairs, can be re-used for fracture testing. Results of fracture tests (conducted in a backwards fall configuration) and cost analysis support both hypotheses. Hence, the bones that had undergone monotonic failure tests of various rotator cuff repair techniques can be re-used in fracture tests because their load-carrying capacity is not significantly reduced.

• bone
• cost analysis
• fracture
• humerus
• in vitro
• rotator cuff repair

• Adult
• Age Factors
• Aged
• Aged, 80 and over
• Female
• Humans
• Male
• Middle Aged
• Prevalence
• Retrospective Studies
• Rotator Cuff/surgery
• Rotator Cuff Injuries
• Rupture/epidemiology
• Rupture/surgery
• Shoulder Fractures
• Texas/epidemiology

• missed fracture
• radiographs

• Classification
• Fracture
• Greater tuberosity
• Morphology
• Proximal humerus

• Arthroscopic internal fixation
• Glenohumeral dislocation
• Greater tuberosity fracture
• Open reduction and internal fixation
• Proximal humerus fracture
• Rotator cuff