Department of Orthopaedic Surgery. Fundación Jiménez Díaz. Madrid, Spain

Purpose: Malunion of displaced fractures of the greater tuberosity can result in subacromial impingement. It is treated with acromioplasty, or and anatomical repositioning of the malunited fragment. This deformity can also be addressed by abrading the protruding proximal portion of the greater tuberosity (tuberoplasty), which requires full elevation of the rotator cuff insertion.

We report on an arthroscopic tuberoplasty based on a combined intra- and extraarticular transtendinous abrasion of the proximal end of the greater tuberosity for malunions with severe upward displacement which permits major conservation of the rotator cuff insertion.

Surgical Technique:  In the first intraarticular step, the proximal portion of the greater tuberosity is abraded under the rotator cuff until the most lateral tendon insertion is reached. In the second bursal step, the tuberoplasty is completed using a burr introduced through a longitudinal window opened in the supraspinatus.  The window is finally sutured arthroscopically.

Six cases (3 women and 3 men) of proximal humeral fracture malunions (3 greater tuberosity fractures and 3 three-part valgus impacted fractures) were performed using this technique. Preliminary reports at a minimum follow-up of one year indicate excellent clinical results with significant improvements in the Constant, ASES and Simple Shoulder Test scores.

Discusion: Arthroscopy proved to be very useful to examine dynamically the whole glenohumeral joint, and to assess the etiology of impingement. Arthroscopic transtendinous tuberoplasty is effective in relieving subacromial impingement secondary to greater tuberosity malunion, and preserves tendon insertion. It should be considered in symptomatic malunions of proximal humeral fractures with upward displacement of the greater tuberosity.