2024, Vol. 28 ›› Issue (24): 3855-3861

Modified calcaneal plate combined with suture anchors in treatment of comminuted fracture of split-type greater tuberosity of humerus (Liu-Gang type IV)

Liu Gang1, 2, Zhang Baolu3, Li Ruichen1, 2, Hou Xiaomei4, Luo Hong1, 2, Lai Canhao1, 2, Li Qingyuan5, Liang Xia6, Bao Dingsu1, 2, Fu Shijie1, 2, Zeng Shengqiang1, 2   

Abstract: BACKGROUND: Numerous scholars have previously researched certain greater tuberosity fractures and the procedures used to treat them. Few researchers, however, have studied the comminuted split fracture of the greater tuberosity of the humerus (Liu-Gang type IV) with rotator cuff tear in great detail.
OBJECTIVE: To compare the clinical therapeutic effect of open repair position modified calcaneal plate combined with suture anchors and proximal humeral internal locking system (PHILOS) plate in the treatment of comminuted fracture of split-type greater tuberosity of humerus combined with rotator cuff tears (Liu-Gang type IV).
METHODS: Case data of 30 patients with comminuted fracture of split-type greater tuberosity of humerus combined with rotator cuff tears (Liu-Gang type IV) from May 2012 to May 2022 were retrospectively analyzed. They were divided into the modified calcaneal plate combined with suture anchor group (group A) and the PHILOS with #2 Johnson group (group B), with 15 cases in each group. Intraoperative blood loss, surgical time, and incision length of all patients were recorded. Pain visual analog scale score, Constant-Murley score, as well as shoulder joint abduction, forward flexion, external rotation, and dorsal expansion activities during the last follow-up (> 1 year) were evaluated.
RESULTS AND CONCLUSION: (1) The surgical incision length and operation time were shorter, and blood loss was less in group A than those in group B (P < 0.05). (2) No significant difference in visual analog scale score and Constant-Murley score was detected between the two groups (P > 0.05). (3) During the last follow-up, forward flexion in group A was better than that in group B (P < 0.05). No significant difference in abduction, external rotation, and dorsal expansion was determined between group A and group B (P > 0.05). (4) In terms of complications, there was 1 case of shoulder joint pain and discomfort in group A (7%), 2 cases of subacromial impingement syndrome, 2 cases of upward movement of nodules, and 2 cases of shoulder joint pain (40%) in group B. There were significant differences in complication rates between the two groups (P=0.031). (5) In summary, the modified calcaneal plate combined with suture anchors in the treatment of comminuted fracture of split-type greater tuberosity of humerus combined with rotator cuff tears (Liu-Gang type IV) could better restore the forward flexion function of the shoulder joint and has a small incision, less blood loss, shorter operation time and fewer complications.

Key words: split-type greater tuberosity of humerus, Liu-Gang type IV, new classification, surgical treatment, modified calcaneal plate, PHILOS plate