<div class="section">
<a class="named-anchor" id="d5342138e134">
<!--
named anchor
-->
</a>
<h5 class="section-title" id="d5342138e135">Background</h5>
<p id="d5342138e137">Arthroscopic double-row suture-anchor fixation and open reduction
and internal fixation
(ORIF) are used to treat displaced greater tuberosity fractures, but there are few
data that can help guide the surgeon in choosing between these approaches.
</p>
</div><div class="section">
<a class="named-anchor" id="d5342138e139">
<!--
named anchor
-->
</a>
<h5 class="section-title" id="d5342138e140">Questions/Purposes</h5>
<p id="d5342138e142">We therefore asked: (1) Is there a difference in surgical time
between arthroscopic
double-row suture anchor fixation and ORIF for isolated displaced greater tuberosity
fractures? (2) Are there differences in the postoperative ROM and functional scores
between arthroscopic double-row suture anchor fixation and ORIF for isolated displaced
greater tuberosity fractures? (3) Are there differences in complications resulting
in additional operations between the two approaches?
</p>
</div><div class="section">
<a class="named-anchor" id="d5342138e144">
<!--
named anchor
-->
</a>
<h5 class="section-title" id="d5342138e145">Methods</h5>
<p id="d5342138e147">Between 2006 and 2012, we treated 79 patients surgically for
displaced greater tuberosity
fractures. Of those, 32 (41%) were considered eligible for our study based on inclusion
criteria for isolated displaced greater tuberosity fractures with a displacement of
at least 5 mm but less than 2 cm. During that time, we generally treated patients
with displaced greater tuberosity fractures with a displacement greater than 1 cm
or with a fragment size greater than 3×3 cm with open treatment, and patients with
displaced greater tuberosity fractures with a displacement less than 1 cm or with
a fragment size less than 3×3 cm with arthroscopic treatment. Fifty-three underwent
open treatment based on those indications, and 26 underwent arthroscopic treatment,
of whom 17 (32%) and 15 (58%) were available for followup at a mean of 34 months (range,
24–28 months). All patients with such fractures identified from our institutional
database were treated by these two approaches and no other methods were used. Surgical
time was defined as the time from initiation of the incision to the time when suture
of the incision was finished, and was determined by an observer with a stopwatch.
Patients were followed up in the outpatient department at 6, 12, and 24 weeks, and
every 6 month thereafter. Radiographs showed optimal reduction immediately after surgery
and at every followup. Radiographs were obtained to assess fracture healing. Patients
were followed up for a mean of 34 months (range, 24–48 months). At the last followup,
ROM, VAS score, and American Shoulder and Elbow Surgeons (ASES) score were used to
evaluate clinical outcomes. All these data were retrieved from our institutional database
through chart review. Complications were assessed through chart review by one observer
other than the operating surgeon.
</p>
</div><div class="section">
<a class="named-anchor" id="d5342138e149">
<!--
named anchor
-->
</a>
<h5 class="section-title" id="d5342138e150">Results</h5>
<p id="d5342138e152">Patients who underwent arthroscopic double-row suture anchor
fixation had longer surgical
times than did patients who underwent ORIF (mean, 95.3 minutes, SD, 10.6 minutes vs
mean, 61.5 minutes, SD, 7.2 minutes; mean difference, 33.9 minutes; 95% CI, 27.4–40.3
minutes; p < 0.001). All patients achieved bone union within 3 months. Compared
with
patients who had ORIF, the patients who had arthroscopic double-row suture anchor
fixation had greater ranges of forward flexion (mean, 152.7°, SD, 13.3° vs mean, 137.7°,
SD, 19.2°; p = 0.017) and abduction (mean, 146.0°, SD, 16.4° vs mean, 132.4°, SD,
20.5°; p = 0.048), and higher ASES score (mean, 91.8 points, SD, 4.1 points vs mean,
87.4 points, SD, 5.8 points; p = 0.021); however, in general, these differences were
small and of questionable clinical importance. With the numbers available, there were
no differences in the proportion of patients experiencing complications resulting
in reoperation; secondary subacromial impingement occurred in two patients in the
ORIF group and postoperative stiffness in one from the ORIF group. The two patients
experiencing secondary subacromial impingement underwent reoperation to remove the
implant. The patient with postoperative stiffness underwent adhesion release while
receiving anesthesia, to improve the function of the shoulder. These three patients
had the only reoperations.
</p>
</div><div class="section">
<a class="named-anchor" id="d5342138e154">
<!--
named anchor
-->
</a>
<h5 class="section-title" id="d5342138e155">Conclusions</h5>
<p id="d5342138e157">We found that in the hands of surgeons comfortable with both
approaches, there were
few important differences between arthroscopic double-row suture anchor fixation and
ORIF for isolated displaced greater tuberosity fractures. Future, larger studies with
consistent indications should be performed to compare these treatments; our data can
help inform sample-size calculations for such studies.
</p>
</div><div class="section">
<a class="named-anchor" id="d5342138e159">
<!--
named anchor
-->
</a>
<h5 class="section-title" id="d5342138e160">Level of Evidence</h5>
<p id="d5342138e162">Level III, therapeutic study.</p>
</div>