Comparison of The Efficacy of Anchor and Hollow Lag Screw in the Treatment of Humerus Greater Tubercle Fracture

Long Guangwei; Yao Jun

Abstract：Objective To compare the efficacy of anchor and hollow lag screw in the treatment of humerus greater tubercle fracture.Methods A retrospective analysis was conducted on the data of 40 patients with simple greater tuberosity fractures of the humerus admitted to Qianhai Life Insurance Guangxi Hospital and the First Affiliated Hospital of Guangxi Medical University from January 2014 to January 2019.There were 20 cases in the anchor nail group,including 7 males and 13 females,aged 33 to 62 years,with an average age of(48.20±14.68)years.There were 20 cases in the hollow nail group,including 5 males and 15 females,aged 30 to 60 years,with an average age of(45.65±14.75)years.The anchor nail group was fixed with two anchors through a small lateral acromion incision via the deltoid approach.The hollow nail group was fixed with two hollow lag screws via the deltoid approach.Postoperatively,the affected limb was immobilized with a medical forearm fixation belt for suspension braking in the first 4 weeks,and the medical forearm fixation belt was removed after 4 weeks.Pendulum motion exercise of the shoulder joint was started on the second day after surgery,and active exercise of the shoulder joint in all directions was started at 4～6 weeks.Regular reexaminations and follow-ups were performed at the hospital in the first six months after surgery and every six months thereafter.DR films of the shoulder were taken,and CT examinations were performed if necessary to better understand the fracture healing.At the last follow-up,the fracture healing time,Fudan university shoulder score(FUSS),visual analogue scale(VAS),postoperative complications such as fracture redisplacement and acromial impingement,and the rate of secondary operations were recorded.Results All 40 patients were followed up for 12 to 24 months,with an average of(18.00±6.00)months,and all achieved good bony union.The average bone healing time was(12.40±1.35)weeks in the anchor nail group and(12.50±1.15)weeks in the hollow nail group,with no statistically significant difference between the two groups(P＞0.05).At the last follow-up,the FUSS score was(95.10±2.07)points in the anchor nail group and(90.90±2.94)points in the hollow nail group,with a statistically significant difference(P＜0.05).The VAS score was(1.35±0.93)points in the anchor nail group and(2.10±0.85)points in the hollow nail group,with a statistically significant difference(P＜0.05).Regarding postoperative complications,the incidences of fracture redisplacement,acromial impingement,and reoperation in the anchor nail group were lower than those in the hollow nail group,and the differences between the two groups were statistically significant(P＜0.05).Conclusion For the treatment of greater tuberosity fractures of the humerus,anchor fixation has significant efficacy compared with hollow lag screw fixation.It provides stronger mechanical stability,achieves better recovery of shoulder joint function,and significantly reduces the incidence of complications(especially acromial impingement and fracture redisplacement)and the rate of secondary operations.