Department of Orthopedic Surgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea.
Shoulder Center, Department of Orthopedic Surgery, TanTan Hospital, Daejeon, Korea.
Clin Orthop Surg. 2021 Sep;13(3):293-300. doi: 10.4055/cios20212. Epub 2021 Apr 1.
The best treatment for isolated greater tuberosity (GT) fractures is still controversial. Although previous studies have suggested surgical options, they are either unable to provide firm fixation or present with a variety of complications.
We retrospectively studied the records of patients with isolated GT fractures who underwent open reduction and internal fixation using a 3.5-mm locking hook plate between January 2016 and January 2018. The surgical indication was an at least 5-mm displacement of the GT as observed in either simple radiography or three-dimensional computed tomography. Clinical outcomes were assessed using the following five parameters shortly before implant removal and at the final follow-up: visual analog scale (VAS) pain score, American Shoulder and Elbow Surgeons (ASES) score, Shoulder Rating Scale of the University of California, Los Angeles (UCLA), Constant-Murley score, and range of motion.
Twenty-one patients with a mean age of 64 years were included. Bone union was achieved within 12-20 weeks of the first surgery in all patients. Implant removal was performed between 13 and 22 weeks after surgery. At the final follow-up, the mean VAS pain score, forward flexion, abduction, external rotation, internal rotation, ASES score, UCLA score, and Constant-Murley score were significantly better when compared to outcomes shortly before implant removal ( < 0.001, < 0.001, < 0.001, = 0.008, = 0.003, < 0.001, < 0.001, and < 0.001, respectively).
The 3.5-mm locking hook plate provided sufficient stability and led to satisfactory clinical and radiological outcomes for isolated GT fractures. However, the hook plate may irritate the rotator cuff, and postoperative stiffness may be inevitable. Therefore, second surgery for implant removal is necessary after bone union is achieved.
孤立性大结节（GT）骨折的最佳治疗方法仍存在争议。尽管先前的研究表明了手术选择，但它们要么无法提供牢固的固定，要么存在各种并发症。
我们回顾性研究了 2016 年 1 月至 2018 年 1 月期间接受 3.5 毫米锁定钩钢板切开复位内固定治疗的孤立性 GT 骨折患者的病历。手术指征是在常规 X 线或三维 CT 中观察到 GT 至少有 5mm 的移位。在取出内固定前和最后一次随访时，使用以下五个参数评估临床结果：视觉模拟评分（VAS）疼痛评分、美国肩肘外科医师协会（ASES）评分、加州大学洛杉矶分校（UCLA）肩部评分、Constant-Murley 评分和活动范围。
共纳入 21 例患者，平均年龄 64 岁。所有患者在首次手术后 12-20 周内均实现了骨愈合。在手术后 13-22 周进行了内固定取出。在最后一次随访时，与取出内固定前相比，VAS 疼痛评分、前屈、外展、外旋、内旋、ASES 评分、UCLA 评分和 Constant-Murley 评分均显著改善（均 < 0.001）。
3.5 毫米锁定钩钢板提供了足够的稳定性，治疗孤立性 GT 骨折取得了满意的临床和影像学结果。然而，钩钢板可能会刺激肩袖，术后僵硬可能不可避免。因此，在骨愈合后需要进行二次手术取出内固定。
