Plate fixation combined with suture bridge technique for proximal humeral fracture-dislocation with displaced greater tuberosity: a case series

Introduction: Plate fixation is an established procedure for proximal humeral fractures involving the greater tuberosity; however, concomitant glenohumeral dislocation increases the risk of secondary displacement of the greater tuberosity fragments. The suture bridge technique has produced satisfactory outcomes for greater tuberosity fractures; however, little is known about the outcomes of combining plate fixation with the suture bridge technique. We report the surgical technique and outcomes of plate fixation combined with the suture bridge technique for proximal humeral fracture-dislocations with displaced greater tuberosity. Presentation of case: We retrospectively identified six patients who underwent plate fixation combined with a suture bridge technique. Using the deltopectoral approach, we reduced the fractured fragments. We inserted medial anchors into the proximal margin of the humeral fracture surface and distal anchors into the shaft, and fixed the greater tuberosity fragments using the suture bridge technique. The fractured fragments were fixed using a locking plate. We evaluated postoperative shoulder functional scores and complications. The mean Constant score was 86, and the American Shoulder and Elbow Surgeons score was 85 at 1 year postoperatively. No major postoperative complications were observed. Discussion: The procedure yielded satisfactory functional and radiological outcomes. Plate fixation combined with the suture bridge technique allows for more secure fixation of greater tuberosity fragments than conventional procedures, potentially preventing greater tuberosity displacement postoperatively. Conclusion: This case series presents a new fixation procedure for proximal humeral fractures, which can be advantageous in patients with a high risk of postoperative greater tuberosity displacement.