Self-made dentation hook plate associated with hot-air balloon technique on treatment of Mutch <b>Ⅰ</b> or <b>Ⅱ</b> type isolated greater tuberosity fractures of humerus_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WEI Changbao , RUI Yongjun , WU Yongwei , MA Yunhong , ZHOU Ming , KANG Yongqiang , WANG Yapeng ,  LIU Jun

Department of Orthopedics, Wuxi Ninth People’s Hospital, Suzhou University, Wuxi Jiangsu, 214062, P.R.China;

Corresponding?author：

LIU Jun, Email: 469225762@qq.com

Keywords：

Greater tuberosity of humerus; isolated fracture; dentation hook plate; hot air balloon technique

DOI：

10.7507/1002-1892.202002104

Video：

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Objective To observe effectivness and safeness of self-made dentation hook plate associated with hot-air balloon technique in treating Mutch Ⅰ or Ⅱ type isolated greater tuberosity fractures of humerus.Methods Between January 2016 and December 2018, 15 patients with Mutch Ⅰ or Ⅱ type greater tuberosity fractures were treated with self-made dentation hook plate associated with hot-air balloon technique. There were 9 males and 6 females with an average age of 45.1 years (range, 29-62 years). The injury causes included falling injury in 9 patients and traffic accident injury in 6 patients. According to Mutch classification, 4 cases were MutchⅠ type and 11 cases were Mutch Ⅱ type. There were 7 cases with anterior dislocation of shoulder. The time from injury to operation was 2-10 days (mean, 4.5 days).Results All 15 patients were followed up 8-16 months, with an average of 13.5 months. There was no infection of incision, loss of reduction of fracture block, delayed union or nonunion. The average time of fracture union was 6.5 months (range, 4-8 months). One patient had axillary paralysis at 1 day after operation, and was treated with nutritional nerve therapy, the symptoms disappeared after 2.5 months. Three patients had slight subacromial impingement. After fracture healing, the hook plate was taken out in advance, and the pain and abnormal noise disappeared during shoulder abduction. At last follow-up, Costant-Murley score used to evaluate shoulder joint function was 88-100, with an average of 96.8; 8 cases were excellent, 7 cases were good, and the excellent and good rate was 100%. The internal fixator was removed after 8-16 months after the secondary operation with no re-fracture occurred.Conclusion The self-made dentation hook plate associated with hot-air balloon technique is a safe and reliable method for the treatment of Mutch Ⅰ or Ⅱ type isolated greater tuberosity fracture of humerus.

Citation： WEI Changbao, RUI Yongjun, WU Yongwei, MA Yunhong, ZHOU Ming, KANG Yongqiang, WANG Yapeng, LIU Jun. Self-made dentation hook plate associated with hot-air balloon technique on treatment of Mutch Ⅰ or Ⅱ type isolated greater tuberosity fractures of humerus. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(9): 1120-1124. doi: 10.7507/1002-1892.202002104 Copy

1.	Beks RB, Ochen Y, Frima H, et al. Operative versus nonoperative treatment of proximal humeral fractures: a systematic review, meta-analysis, and comparison of observational studies and randomized controlled trials. J Shoulder Elbow Surg, 2018, 27(8): 1526-1534.
2.	李文慶, 張作君, 劉云龍. 肱骨近端脫套樣骨折治療體會. 中國修復重建外科雜志, 2018, 32(12): 1540-1544.
3.	Shaw L, Hong C, Kuan F, et al. The incidence of occult and missed surgical neck fractures in patients with isolated greater tuberosity fracture of the proximal humerus. BMC Musculoskelet Disord, 2019, 20(1): 482.
4.	Longo UG, Corbett S, Ahrens PM, et al. Missed fractures of the greater tuberosity. BMC Musculoskelet Disord, 2018, 19(1): 313.
5.	Dimakopoulos P, Panagopoulos A, Kasimatis G, et al. Anterior traumatic shoulder dislocation associated with displaced greater tuberosity fracture: The necessity of operative treatment. J Orthop Trauma, 2007, 21(2): 104-112.
6.	Green A, Izzi J Jr. Isolated fractures of the greater tuberosity of the proximal humerus. J Shoulder Elbow Surg, 2003, 12(6): 641-649.
7.	Williams GR Jr, Wong KL. Two-part and three-part fractures: open reduction and internal fixation versus closed reduction and percutaneous pinning. Orthop Clin North Am, 2000, 31(1): 1-21.
8.	Rouleau DM, Mutch J, Laflamme GY. Surgical treatment of displaced greater tuberosity fractures of the humerus. J Am Acad Orthop Surg, 2016, 24(1): 46-56.
9.	Levy DM, Erickson BJ, Harris JD, et al. Management of isolated greater tuberosity fractures: A systematic review. Am J Orthop (Belle Mead NJ), 2017, 46(6): E445-E453.
10.	White EA, Skalski MR, Patel DB, et al. Isolated greater tuberosity fractures of the proximal humerus: anatomy, injury patterns, multimodality imaging, and approach to management. Emerg Radiol, 2018, 25(3): 235-246.
11.	Pitcher A, Langhammer C, Feeley BT. Utility of MRI in the evaluation of acute greater tuberosity proximal humeral fractures. Orthop J Sports Med, 2019, 7(6): 1810898896.
12.	Schliemann B, Heilmann LF, Raschke MJ, et al. Isolated fractures of the greater tuberosity: When are they treated conservatively?: A baseline study. Obere Extrem, 2018, 13(2): 106-111.
13.	Mutch J, Laflamme GY, Hagemeister N, et al. A new morphological classification for greater tuberosity fractures of the proximal humerus: Validation and clinical implications. Bone Joint J, 2014, 96-B(5): 646-651.
14.	楊國勇, 向明, 陳杭, 等. 關節鏡下中空螺釘和(或)錨釘縫線橋技術固定肱骨大結節骨折. 中華骨科雜志, 2017, 37(21): 1342-1349.
15.	Choi S, Son I, Hyun MJ, et al. Arthroscopic treatment of greater tuberosity fractures: retrospective review of clinical and radiological outcomes. Acta Orthop Belg, 2018, 84(1): 47-53.
16.	曾浪清, 陳云豐, 曾路路, 等. 單純肱骨大結節骨折的診療研究進展. 中華肩肘外科電子雜志, 2018, 6(4): 313-318.
17.	Yoon TH, Choi CH, Choi YR, et al. Clinical outcomes of minimally invasive open reduction and internal fixation by screw and washer for displaced greater tuberosity fracture of the humerus. J Shoulder Elbow Surg, 2018, 27(6): e173-e177.
18.	Brais G, Ménard J, Mutch J, et al. Transosseous braided-tape and double-row fixations are better than tension band for avulsion-type greater tuberosity fractures. Injury, 2015, 46(6): 1007-1012.
19.	Park JY, Kim JH, Lhee SH, et al. The importance of inferomedial support in the hot air balloon technique for treatment of 3-part proximal humeral fractures. J Shoulder Elbow Surg, 2012, 21(9): 1152-1159.
20.	劉軍, 黎逢峰, 吳永偉, 等. 自制齒狀鉤鋼板結合熱氣球技術治療合并側方碎骨塊的尺骨鷹嘴撕脫骨折. 中國修復重建外科雜志, 2019, 33(8): 1048-1050.
21.	劉軍, 芮永軍, 吳永偉, 等. 自制齒狀鉤鋼板治療后交叉韌帶脛骨止點撕脫骨折. 中國修復重建外科雜志, 2017, 31(6): 765-767.
22.	Cheng MF, Hung SH, Su YP, et al. Displaced isolated greater tuberosity fractures of elder adults treated with plate osteosynthesis. J Chin Med Assoc, 2019, 82(4): 318-321.
23.	Smith J, Berry G, Laflamme Y, et al. Percutaneous insertion of a proximal humeral locking plate: An anatomic study. Injury, 2007, 38(2): 206-211.
24.	單記春, 邵銀初, 鄒鴻星, 等. 復雜肱骨近端骨折 Philos 鋼板內固定手術技巧及并發癥分析. 中國骨與關節損傷雜志, 2018, 33(9): 989-991.

1. Beks RB, Ochen Y, Frima H, et al. Operative versus nonoperative treatment of proximal humeral fractures: a systematic review, meta-analysis, and comparison of observational studies and randomized controlled trials. J Shoulder Elbow Surg, 2018, 27(8): 1526-1534.
2. 李文慶, 張作君, 劉云龍. 肱骨近端脫套樣骨折治療體會. 中國修復重建外科雜志, 2018, 32(12): 1540-1544.
3. Shaw L, Hong C, Kuan F, et al. The incidence of occult and missed surgical neck fractures in patients with isolated greater tuberosity fracture of the proximal humerus. BMC Musculoskelet Disord, 2019, 20(1): 482.
4. Longo UG, Corbett S, Ahrens PM, et al. Missed fractures of the greater tuberosity. BMC Musculoskelet Disord, 2018, 19(1): 313.
5. Dimakopoulos P, Panagopoulos A, Kasimatis G, et al. Anterior traumatic shoulder dislocation associated with displaced greater tuberosity fracture: The necessity of operative treatment. J Orthop Trauma, 2007, 21(2): 104-112.
6. Green A, Izzi J Jr. Isolated fractures of the greater tuberosity of the proximal humerus. J Shoulder Elbow Surg, 2003, 12(6): 641-649.
7. Williams GR Jr, Wong KL. Two-part and three-part fractures: open reduction and internal fixation versus closed reduction and percutaneous pinning. Orthop Clin North Am, 2000, 31(1): 1-21.
8. Rouleau DM, Mutch J, Laflamme GY. Surgical treatment of displaced greater tuberosity fractures of the humerus. J Am Acad Orthop Surg, 2016, 24(1): 46-56.
9. Levy DM, Erickson BJ, Harris JD, et al. Management of isolated greater tuberosity fractures: A systematic review. Am J Orthop (Belle Mead NJ), 2017, 46(6): E445-E453.
10. White EA, Skalski MR, Patel DB, et al. Isolated greater tuberosity fractures of the proximal humerus: anatomy, injury patterns, multimodality imaging, and approach to management. Emerg Radiol, 2018, 25(3): 235-246.
11. Pitcher A, Langhammer C, Feeley BT. Utility of MRI in the evaluation of acute greater tuberosity proximal humeral fractures. Orthop J Sports Med, 2019, 7(6): 1810898896.
12. Schliemann B, Heilmann LF, Raschke MJ, et al. Isolated fractures of the greater tuberosity: When are they treated conservatively?: A baseline study. Obere Extrem, 2018, 13(2): 106-111.
13. Mutch J, Laflamme GY, Hagemeister N, et al. A new morphological classification for greater tuberosity fractures of the proximal humerus: Validation and clinical implications. Bone Joint J, 2014, 96-B(5): 646-651.
14. 楊國勇, 向明, 陳杭, 等. 關節鏡下中空螺釘和(或)錨釘縫線橋技術固定肱骨大結節骨折. 中華骨科雜志, 2017, 37(21): 1342-1349.
15. Choi S, Son I, Hyun MJ, et al. Arthroscopic treatment of greater tuberosity fractures: retrospective review of clinical and radiological outcomes. Acta Orthop Belg, 2018, 84(1): 47-53.
16. 曾浪清, 陳云豐, 曾路路, 等. 單純肱骨大結節骨折的診療研究進展. 中華肩肘外科電子雜志, 2018, 6(4): 313-318.
17. Yoon TH, Choi CH, Choi YR, et al. Clinical outcomes of minimally invasive open reduction and internal fixation by screw and washer for displaced greater tuberosity fracture of the humerus. J Shoulder Elbow Surg, 2018, 27(6): e173-e177.
18. Brais G, Ménard J, Mutch J, et al. Transosseous braided-tape and double-row fixations are better than tension band for avulsion-type greater tuberosity fractures. Injury, 2015, 46(6): 1007-1012.
19. Park JY, Kim JH, Lhee SH, et al. The importance of inferomedial support in the hot air balloon technique for treatment of 3-part proximal humeral fractures. J Shoulder Elbow Surg, 2012, 21(9): 1152-1159.
20. 劉軍, 黎逢峰, 吳永偉, 等. 自制齒狀鉤鋼板結合熱氣球技術治療合并側方碎骨塊的尺骨鷹嘴撕脫骨折. 中國修復重建外科雜志, 2019, 33(8): 1048-1050.
21. 劉軍, 芮永軍, 吳永偉, 等. 自制齒狀鉤鋼板治療后交叉韌帶脛骨止點撕脫骨折. 中國修復重建外科雜志, 2017, 31(6): 765-767.
22. Cheng MF, Hung SH, Su YP, et al. Displaced isolated greater tuberosity fractures of elder adults treated with plate osteosynthesis. J Chin Med Assoc, 2019, 82(4): 318-321.
23. Smith J, Berry G, Laflamme Y, et al. Percutaneous insertion of a proximal humeral locking plate: An anatomic study. Injury, 2007, 38(2): 206-211.
24. 單記春, 邵銀初, 鄒鴻星, 等. 復雜肱骨近端骨折 Philos 鋼板內固定手術技巧及并發癥分析. 中國骨與關節損傷雜志, 2018, 33(9): 989-991.

Chinese Journal of Reparative and Reconstructive Surgery

Self-made dentation hook plate associated with hot-air balloon technique on treatment of Mutch Ⅰ or Ⅱ type isolated greater tuberosity fractures of humerus

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