Arthroscopic Reduction and Transosseous Suture Fixation of Avulsed Displaced Shoulder Greater Tuberosity Fracture

The results of conservative treatment of displaced proximal humerus fractures are not satisfactory. Open reconstruction and rigid internal fixation, as well as arthroscopic-assisted reduction and internal fixation, are possible in selected cases, mostly young patients. Older patients with osteoporotic, comminuted bone accounts for 70% of the cases. We present an arthroscopic reduction and transosseous suture fixation technique for osteoporotic patients with displaced 2-part greater tuberosity fractures of the proximal humerus. The technique reduces the upward and medially displaced greater tuberosity to its anatomic position and uses longitudinal, horizontal, or a mattress suture fixation as single or combined fixation (Natofix technique).