Self-developed micro-tooth porous anatomical plate versus double-row suture bridge technique in the treatment of humeral greater tuberosity fractures

The treatment of humeral greater tuberosity fractures mainly falls into two categories: open reduction and internal fixation, and arthroscopic anchor-assisted reduction and internal fixation. Open reduction and internal fixation predominantly adopts the conventional proximal PHILOS locking plate. However, this implant is more suitable for humeral surgical neck fractures and occupies excessive volume for the greater tuberosity. By contrast, arthroscopic reduction is technically demanding and associated with prolonged operative time. The objective of this study was to evaluate the clinical efficacy of self-developed micro-tooth porous anatomical plate and double-row suture bridge technique in the treatment of humeral greater tuberosity fractures. A retrospective analysis was conducted on 66 patients with humeral greater tuberosity fractures treated by surgical internal fixation from January 2020 to June 2024 in our orthopedic department. Among them, 30 patients were treated with self-developed micro-tooth porous anatomical plate (M-T group), and 36 patients were treated with anchor double-row suture bridge internal fixation (suture bridge group). The American Shoulder and Elbow Surgeons (ASES) score and Constant-Murley score were adopted to evaluate clinical efficacy before operation, 6 weeks, 6 months and 12months after operation, respectively. Baseline data were comparable between the two groups, and all patients completed effective follow-up with a follow-up period of 12–24 (17.17 ± 3.83) months. Compared with the double-row suture bridge group, the M-T group had more intraoperative blood loss, longer incision length, more operation time but superior fracture reduction quality ( P < 0.05). The fracture healing time were similar between the two groups ( P > 0.05). The ASES and Constant-Murley scores of both groups were significantly improved compared with those before operation; the M-T group achieved better scores at 6week postoperative stage ( P < 0.05). There was no significant difference in ASES and Constant-Murley scores between the two groups at 6 months and 12 months postoperatively ( P > 0.05). No significant difference was found in the incidence of complications between the two groups (X2 = 0.869,df = 1, P > 0.05). Both micro-tooth porous anatomical plate and double-row suture bridge technique can effectively reduce humeral greater tuberosity fractures with convenient operation, and repair damaged rotator cuff without injuring intact rotator cuff. The micro-tooth plate presents high reduction quality and reliable fixation, which supports early(6 weeks) functional exercise, whereas secondary surgery for implant removal is required. The double-row suture bridge technique has the advantages of minimal trauma and no need for implant removal, but its fixation stability is relatively insufficient.