肱骨大结节骨折席智杰
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CT findings An artist’s rendition (a), anteroposterior radiograph (b), coronal CT view (c) and axial CT view (d) of the depression-type fracture. Note the impaction of the GT fragment into the humeral head
Malunion of the greater tuberosity can cause mechanical impingement on the subacromial arch
After diagnostic evaluation with the arthroscope in the standard posterior portal
CT findings
CT Wndings.
The lesser tuberosity was markedly displaced medially, and approximately 1/3 of the bone fragment extended beyond the anterior margin of the glenoid fossa
Case 1
Postoperative radiographic findings
United bone was conWrmed at 3 months postoperatively.
Case 2
a True anteroposterior radiograph and 3D CT
a Intra-articular aspect of the humeral head and subscapularis tendon with haematoma surrounding the fracture gap. b Insertion of the cranial suture anchor next to the lesser tuberosity. c Transtendinous subscapularis perforation for mattress stitch configuration. d The dislocated medial aspect of the greater tuberosity fragment is reduced using an examination hook. e The posterior transtendinous suture anchor is inserted for greater tuberosity fixation. f Transtendinous suture passage next to the supraspinatus tendon footprint, about 18 mm apart
Arthroscopic fixation with cannulated screws for isolated greater tuberosity fractures
Zhi-jie Xi, M.D.
Department of Orthopaedics，Shanghai Guanghua Hospital of Integrated Traditional Chinese and Western Medicine，Shanghai
The tuberoplasty of the malunited greater tuberosity is seen on plain radiograph
Plain radiographic
These Wndings revealed a fracture of the lesser tuberosity and a
Acromial impression fracture of the greater tuberosity with massive rotator cuff tear: this need not be a nightmare! ——Case 6
• Plain radiograph, AP view showing avulsion fracture of the superolateral end, proximal humerus
Acromial impression fracture of the greater tuberosity with massive rotator cuff tear: this need not be a nightmare!
Suture anchors are placed at the articular margin
Suture anchors are placed at the articular margin to create a medial row (A, B). A suture strand from each anchor in the medial row is retrieved. The PushLock anchor is advanced into the pilot
Case 5
3D-CT scan of the shoulder showing a proximal and
Arthroscopic findings of a malunited greater tuberosity
Arthroscopic findings showing the suture-bridge technique of the osteotomizedБайду номын сангаасfragment
morphological classification
An avulsion fracture
morphological classification
A split fracture
morphological classification
A depressed fractur
morphological classification
Anatomy
• The greater tuberosity as the insertion of rotator cuff ,once fracture, due to retraction of rotator cuff ,would displace posterior or suprertior
Three-dimensional CT Wndings
3-D CT is helpful to classify and choice a good fixation
Three-dimensional CT Wndings
The greater tuberosity was also fractured, and was
3D-CT scan of the shoulder showing a proximal and
Arthroscopic findings of a malunited greater tuberosity
Acromial impression fracture of the greater tuberosity with massive rotator cuff tear: this need not be a nightmare! ——Case 6
MRI of the shoulder showing a proximally displaced fracture of greater tuberosity with continuity of the supraspinatus tendon at the humeral insertion site on oblique coronal T2
Case 3
a Anteroposterior radiograph showing a greater tuberosity fracture with comminution and dislocation. b Post-reduction magnetic
a Arthroscopic findings showed the superior migration of the greater tuberosity fracture fragment (arrowhead). b The sutures were anchored into the lateral cortex using Versalok anchors for the suture-bridge technique. c, d Arthroscopic and radiographic findings of the final fixation of the greater tuberosity fracture by the use of two inverted mattress sutures and two lateral anchors
Case 2
a Fluoroscopy control of proper reduction and temporary fixation of the greater tuberosity, prior to cannulated drilling for screw insertion. b Final intra-articular aspect. c X-ray follow-up (true a.p.) at 6 weeks postoperatively: the fracture line around the distal greater tuberosity is not yet fully consolidated. d Three dimensional reconstruction of a follow-up CT-scan at 6 months postoperatively, showing anatomic integration of the fragments Case 2
(A), we debride the articular-side rotator cuff and malunited greater tuberosity in the glenohumeral joint (B). Accurate
To open the rotator cuff –attached malunited greater tuberosity
Case 4
Anteroposterior radiograph of the shoulder showing incomplete union of the greater tuberosity fragment with radiolucent gapping and marginal sclerosis, and proximally displaced deformity
MRI fingdings
MRI is a good choice for occult fracture or combing with soft-
Surgery or conservative treatment ?
Displacement >2mm shoulder be treat with surgery
We open the rotator cuff–attached malunited greater tuberosity using a shaver as a full-thickness rotator cuff tear under subacromial arthroscopic vision (A, B). The superior displaced
Malunion of the greater tuberosity can cause mechanical impingement on the subacromial arch
After diagnostic evaluation with the arthroscope in the standard posterior portal
CT findings
CT Wndings.
The lesser tuberosity was markedly displaced medially, and approximately 1/3 of the bone fragment extended beyond the anterior margin of the glenoid fossa
Case 1
Postoperative radiographic findings
United bone was conWrmed at 3 months postoperatively.
Case 2
a True anteroposterior radiograph and 3D CT
a Intra-articular aspect of the humeral head and subscapularis tendon with haematoma surrounding the fracture gap. b Insertion of the cranial suture anchor next to the lesser tuberosity. c Transtendinous subscapularis perforation for mattress stitch configuration. d The dislocated medial aspect of the greater tuberosity fragment is reduced using an examination hook. e The posterior transtendinous suture anchor is inserted for greater tuberosity fixation. f Transtendinous suture passage next to the supraspinatus tendon footprint, about 18 mm apart
Arthroscopic fixation with cannulated screws for isolated greater tuberosity fractures
Zhi-jie Xi, M.D.
Department of Orthopaedics，Shanghai Guanghua Hospital of Integrated Traditional Chinese and Western Medicine，Shanghai
The tuberoplasty of the malunited greater tuberosity is seen on plain radiograph
Plain radiographic
These Wndings revealed a fracture of the lesser tuberosity and a
Acromial impression fracture of the greater tuberosity with massive rotator cuff tear: this need not be a nightmare! ——Case 6
• Plain radiograph, AP view showing avulsion fracture of the superolateral end, proximal humerus
Acromial impression fracture of the greater tuberosity with massive rotator cuff tear: this need not be a nightmare!
Suture anchors are placed at the articular margin
Suture anchors are placed at the articular margin to create a medial row (A, B). A suture strand from each anchor in the medial row is retrieved. The PushLock anchor is advanced into the pilot
Case 5
3D-CT scan of the shoulder showing a proximal and
Arthroscopic findings of a malunited greater tuberosity
Arthroscopic findings showing the suture-bridge technique of the osteotomizedБайду номын сангаасfragment
morphological classification
An avulsion fracture
morphological classification
A split fracture
morphological classification
A depressed fractur
morphological classification
Anatomy
• The greater tuberosity as the insertion of rotator cuff ,once fracture, due to retraction of rotator cuff ,would displace posterior or suprertior
Three-dimensional CT Wndings
3-D CT is helpful to classify and choice a good fixation
Three-dimensional CT Wndings
The greater tuberosity was also fractured, and was
3D-CT scan of the shoulder showing a proximal and
Arthroscopic findings of a malunited greater tuberosity
Acromial impression fracture of the greater tuberosity with massive rotator cuff tear: this need not be a nightmare! ——Case 6
MRI of the shoulder showing a proximally displaced fracture of greater tuberosity with continuity of the supraspinatus tendon at the humeral insertion site on oblique coronal T2
Case 3
a Anteroposterior radiograph showing a greater tuberosity fracture with comminution and dislocation. b Post-reduction magnetic
a Arthroscopic findings showed the superior migration of the greater tuberosity fracture fragment (arrowhead). b The sutures were anchored into the lateral cortex using Versalok anchors for the suture-bridge technique. c, d Arthroscopic and radiographic findings of the final fixation of the greater tuberosity fracture by the use of two inverted mattress sutures and two lateral anchors
Case 2
a Fluoroscopy control of proper reduction and temporary fixation of the greater tuberosity, prior to cannulated drilling for screw insertion. b Final intra-articular aspect. c X-ray follow-up (true a.p.) at 6 weeks postoperatively: the fracture line around the distal greater tuberosity is not yet fully consolidated. d Three dimensional reconstruction of a follow-up CT-scan at 6 months postoperatively, showing anatomic integration of the fragments Case 2
(A), we debride the articular-side rotator cuff and malunited greater tuberosity in the glenohumeral joint (B). Accurate
To open the rotator cuff –attached malunited greater tuberosity
Case 4
Anteroposterior radiograph of the shoulder showing incomplete union of the greater tuberosity fragment with radiolucent gapping and marginal sclerosis, and proximally displaced deformity
MRI fingdings
MRI is a good choice for occult fracture or combing with soft-
Surgery or conservative treatment ?
Displacement >2mm shoulder be treat with surgery
We open the rotator cuff–attached malunited greater tuberosity using a shaver as a full-thickness rotator cuff tear under subacromial arthroscopic vision (A, B). The superior displaced