A new biomechanical classification system for split fractures of the humeral greater tuberosity: guidelines for surgical treatment

Journal of Orthopaedic Surgery and Research

Qian Zhao¹  Xiaoguang Guo²  Gang Liu²  Bo Qin²  Shijie Fu²  Dingsu Bao²  Junjie Lu³ 

[1] Department of Breast Surgery, Luzhou Hospital of Traditional Chinese Medicine, Luzhou, Sichuan, China;Department of Orthopedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China;Center for Orthopedic Diseases Research, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China;Expert Workstation in Luzhou, Luzhou, Sichuan, China;Clinical Base of Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Guangdong Province Medical 3D Printing Application Transformation Engineering Technology Research Center, Luzhou, Sichuan, China;Department of Orthopedics, YiXing Traditional Chinese Medicine Hospital, Yixing, Jiangsu, China;

关键词: Humeral greater tuberosity;    Split fracture;    Biomechanical classification;    Rotator cuff tear;    Surgical technique;   

DOI  :  10.1186/s13018-021-02839-y

来源: Springer

【 摘 要 】

BackgroundSplit 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.MethodsWe 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.ResultsThe 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.ConclusionsBiomechanical 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.

【 授权许可】

CC BY