Novel Adaptation of Suture Bridge Technique for Greater Tuberosity Redisplacement Post ORIF With PHILOS- A Technical Note

Vol 6 | Issue 2 | July-December 2020 | page: 15-18 | Khayas Omer Kunheen, MC Tomichan, Rajeev PB, Adarsh Krishna K Bhat

Authors: Khayas Omer Kunheen [1], MC Tomichan [1], Rajeev PB [2], Adarsh Krishna K Bhat [1]

[1] Department of Orthopaedics, Government Medical College Kottayam, Kerala, India.
[2] Caritas hospital and Institute Of Health Sciences, Thellakom, Kottayam, Kerala, India.

Address of Correspondence
Dr. Khayas Omer Kunheen,
Chelat House, P.O Olavanna,Calicut 673019, Kerala, India.


Isolated Greater tuberosity (GT) fractures still pose a therapeutic challenge due to the wide variety of treatment options and lack of proper comparative studies on outcome. Plating still remains a valid option but has several unfavorable effects. One among them is redisplacement of tuberosity postoperatively especially in cases with comminution which may easily be missed in regular plain radiographs. Conventional techniques of fixation may remain insufficient in such scenarios. We hereby propose an adaptation of a described technique, in a 45-year-old male presenting with redisplacement of GT post plate fixation. Open double-row suture bridge construct was used to fix the displaced fragment maintaining the plate insitu and the patient had an excellent functional and radiological outcome on follow-up.
Keywords: Greater tuberosity fracture; Comminution; Double-row fixation; Suture anchor; Suture Bridge technique; PHILOS; Redisplacement.


1. Bahrs C, Lingenfelter E, Fischer F, Walters EM, Schnabel M. Mechanism of injury and morphology of the greater tuberosity fracture. J Shoulder Elbow Surg. 2006 Mar;15(2):140–7.
2. Kim E, Shin HK, Kim CH. Characteristics of an isolated greater tuberosity fracture of the humerus. J Orthop Sci. 2005 Sep;10(5):441–4.
3. Handschin AE, Cardell M, Contaldo C, Trentz O, Wanner GA. Functional results of angular-stable plate fixation in displaced proximal humeral fractures. Injury. 2008 Mar;39(3):306–13.
4. Mutch J, Laflamme GY, Hagemeister N, Cikes A, Rouleau DM. A new morphological classification for greater tuberosity fractures of the proximal humerus: validation and clinical Implications. Bone Jt J. 2014 May;96-B(5):646–51.
5. Park S-E, Jeong J-J, Panchal K, Lee J-Y, Min H-K, Ji J-H. Arthroscopic-assisted plate fixation for displaced large-sized comminuted greater tuberosity fractures of proximal humerus: a novel surgical technique. Knee Surg Sports Traumatol Arthrosc. 2016 Dec;24(12):3892–8.
6. Popp D, Strecker W. A simple and effective implant for displaced fractures of the greater tuberosity: the “Bamberg” plate. Arch Orthop Trauma Surg. 2011 Apr;131(4):509–12.
7. Szyszkowrtz R, Seggl W, Schleifer P, Cundy PJ. Proximal Humeral Fractures: Management Techniques and Expected Results. Clin Orthop. 1993 Jul;292:13–25.
8. Sproul RC, Iyengar JJ, Devcic Z, Feeley BT. A systematic review of locking plate fixation of proximal humerus fractures. Injury. 2011 Apr;42(4):408–13.
9. Bhatia DN, van Rooyen KS, du Toit DF, de Beer JF. Surgical treatment of comminuted, displaced fractures of the greater tuberosity of the proximal humerus: A new technique of double-row suture-anchor fixation and long-term results. Injury. 2006 Oct;37(10):946–52.
10. Flatow EL, Cuomo F, Maday MG, Miller SR, McIlveen SJ, Bigliani LU. Open reduction and internal fixation of two-part displaced fractures of the greater tuberosity of the proximal part of the humerus.: J Bone Jt Surg. 1991 Sep;73(8):1213–8.
11. Green A, Izzi J. Isolated fractures of the greater tuberosity of the proximal humerus. J Shoulder Elbow Surg. 2003 Nov;12(6):641–9.
12. Ji J-H, Jeong J-J, Kim Y-Y, Lee S-W, Kim D-Y, Park S-E. Clinical and radiologic outcomes of arthroscopic suture bridge repair for the greater tuberosity fractures of the proximal humerus. Arch Orthop Trauma Surg. 2017 Jan;137(1):9–17.
13. Lin C-L, Hong C-K, Jou I-M, Lin C-J, Su F-C, Su W-R. Suture anchor versus screw fixation for greater tuberosity fractures of the humerus-a biomechanical study. J Orthop Res. 2012 Mar;30(3):423–8.
14. Song HS, Williams GR. Arthroscopic Reduction and Fixation With Suture-Bridge Technique for Displaced or Comminuted Greater Tuberosity Fractures. Arthrosc J Arthrosc Relat Surg. 2008 Aug;24(8):956–60.
15. Platzer P, Kutscha-Lissberg F, Lehr S, Vecsei V, Gaebler C. The influence of displacement on shoulder function in patients with minimally displaced fractures of the greater tuberosity. Injury. 2005 Oct;36(10):1185–9.
16. Chun J-M, Groh GI, Rockwood CA. Two-part fractures of the proximal humerus. J Shoulder Elbow Surg. 1994 Sep;3(5):273–87.
17. Ji J-H, Shafi M, Song I-S, Kim Y-Y, McFarland EG, Moon C-Y. Arthroscopic Fixation Technique for Comminuted, Displaced Greater Tuberosity Fracture. Arthrosc J Arthrosc Relat Surg. 2010 May;26(5):600–9.
18. Naggar L. Surgical Management of Comminuted, Displaced Greater Tuberosity Fractures: A New Technique of Subacromial Spacer on Top of Double-Row Suture Anchor Fixation. Joints. 2018 Sep;06(03):211–4.
19. Sugaya H, Maeda K, Matsuki K, Moriishi J. Functional and Structural Outcome After Arthroscopic Full-Thickness Rotator Cuff Repair: Single-Row Versus Dual-Row Fixation. Arthrosc J Arthrosc Relat Surg. 2005 Nov;21(11):1307–16.
20. Tuoheti Y, Itoi E, Yamamoto N, Seki N, Abe H, Minagawa H, et al. Contact Area, Contact Pressure, and Pressure Patterns of the Tendon-Bone Interface after Rotator Cuff Repair. Am J Sports Med. 2005 Dec;33(12):1869–74.
21. Solberg BD, Moon CN, Franco DP, Paiement GD. Locked Plating of 3- and 4-Part Proximal Humerus Fractures in Older Patients: The Effect of Initial Fracture Pattern on Outcome. J Orthop Trauma. 2009;23(2):7.

How to Cite this article: Kunheen KO, MC Tomichan , Rajeev PB, Bhat AKK | Novel Adaptation of Suture Bridge Technique for Greater Tuberosity Redisplacement Post ORIF With PHILOSA Technical Note | Trauma International | July-December 2020; 6(2): 15-18.


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