Arthroscopic reduction and fixation with suture-bridge technique for displaced or comminuted greater tuberosity fractures.

Abstract

The arthroscopic suture-bridge technique (transosseous equivalent technique) was initially described for increasing the footprint size during arthroscopic rotator cuff repair. We describe a method in which the same principles are used to fix a displaced or comminuted greater tuberosity fracture. The technique involves reducing the displaced fragment with two medially placed, trans-tendinous anchors and compressing the greater tuberosity using the sutures from these medial anchors in two laterally placed anchors. The two medial anchors are inserted through the junction of the cuff and fragment. The anchor driver can be used as a joystick to reduce the fragment into position. One suture limb of each anchor is passed back through the tendon 5 mm from the original anchor insertion point in the tendon. With the scope in the subacromial space, the sutures from the medial anchors are tied in a mattress configuration. The four suture ends are passed distally over the greater tuberosity and incorporated into two PushLock anchors (4.5 mm; Arthrex, Naples, FL) using the suture-bridge technique. The postoperative rehabilitation protocol is similar to that for rotator cuff repairs.