JSES reviews, reports, and techniques · 2026
Implant-specific rates of post-operative displacement and reoperation in isolated greater tuberosity fracture open reduction and internal fixation.
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Arnold Evan, Knusel Konrad, Rana Shamtej Singh, Ghaderi Siena, Navarro Ronald
Аннотация
BACKGROUND: Isolated fractures of the greater tuberosity (GT) comprise nearly 20% of the fractures of the proximal humerus. The Mutch classification categorizes these injuries by morphology into avulsion (Type I), split (Type 2), and depression (Type 3) patterns. While the efficacy of arthroscopic repair vs. open reduction and internal fixation is well-studied, there is less-convincing data on the comparative effectiveness of different open reduction and internal fixation constructs in GT fracture care.
METHODS: A retrospective review analyzed patients with isolated GT fractures of the humerus from February 2008 to June 2024 from Kaiser Permanente Southern California. Patients were treated with constructs consisting of (1) plate osteosynthesis alone, (2) suture anchors alone, (3) cannulated or solid lag screws alone, (4) combined plate osteosynthesis and screws, or (5) combined plate osteosynthesis and suture anchors. Primary outcomes were the rate of post-operative displacement and reoperation for each construct. A secondary outcome was reason for reoperation.
RESULTS: The study population included 164 patients with a mean age of 52 years (range 20-88 years). The distribution of injuries was 99 Mutch 1 fractures (60.4%), 44 Mutch 2 fractures (26.8%), and 21 Mutch 3 fractures (12.8). There was no significant difference in Mutch 1 fractures between constructs in post-operative displacement (P = .538) or reoperation rates (P = .915). There was no significant difference in Mutch 2 fractures in post-operative displacement between constructs (P = .368); however, the difference in rate of reoperation was significant (P = .034) on univariate analysis. There was no significant difference in Mutch 3 fractures between constructs in post-operative displacement (P = 1) and none required reoperation. There were no significant differences in post-operative displacement or reoperation on multivariate analysis.
CONCLUSION: Overall, we did not find a statistically significant difference in rate of post-operative displacement or reoperation between fixation type for Mutch 1, 2, and 3 fractures on multivariate analysis. Surgeons should use the technique they are most comfortable with to achieve an appropriate reduction to restore proper rotator cuff biomechanics.
METHODS: A retrospective review analyzed patients with isolated GT fractures of the humerus from February 2008 to June 2024 from Kaiser Permanente Southern California. Patients were treated with constructs consisting of (1) plate osteosynthesis alone, (2) suture anchors alone, (3) cannulated or solid lag screws alone, (4) combined plate osteosynthesis and screws, or (5) combined plate osteosynthesis and suture anchors. Primary outcomes were the rate of post-operative displacement and reoperation for each construct. A secondary outcome was reason for reoperation.
RESULTS: The study population included 164 patients with a mean age of 52 years (range 20-88 years). The distribution of injuries was 99 Mutch 1 fractures (60.4%), 44 Mutch 2 fractures (26.8%), and 21 Mutch 3 fractures (12.8). There was no significant difference in Mutch 1 fractures between constructs in post-operative displacement (P = .538) or reoperation rates (P = .915). There was no significant difference in Mutch 2 fractures in post-operative displacement between constructs (P = .368); however, the difference in rate of reoperation was significant (P = .034) on univariate analysis. There was no significant difference in Mutch 3 fractures between constructs in post-operative displacement (P = 1) and none required reoperation. There were no significant differences in post-operative displacement or reoperation on multivariate analysis.
CONCLUSION: Overall, we did not find a statistically significant difference in rate of post-operative displacement or reoperation between fixation type for Mutch 1, 2, and 3 fractures on multivariate analysis. Surgeons should use the technique they are most comfortable with to achieve an appropriate reduction to restore proper rotator cuff biomechanics.