Surgical Discussion

Patient positioning:  The patient was positioned in a beach chair position under general anesthesia combined with peripheral nerve block.

Anatomical surgical approach:  A Mackenzie approach was utilized, involving an incision over the shoulder and detachment of the anterior deltoid's acromial portion. The greater tuberosity fracture was accessed, and traction was applied using sutures. Provisional fixation was achieved with a Kirschner wire. Definitive fixation involved five transosseous high-strength sutures and two 4.0 mm partially threaded screws. Reduction was confirmed intraoperatively with imaging. The deltoid was reattached using transosseous sutures, followed by skin closure.

The surgeon noted that the use of high-strength sutures and screws provided stable fixation of the displaced greater tuberosity fracture. The decision to manage the associated small bony Bankart lesion conservatively was based on its size and clinical presentation.

Postoperative protocol:   Postoperative rehabilitation included immobilization in a sling for initial weeks, followed by gradual passive range of motion exercises progressing to active range of motion as tolerated. Strengthening exercises were introduced in later stages of rehabilitation.

Follow up:   Not specified.

Orthopaedic implants used:   Kirschner wire, 5 high-strength transosseous sutures, two 4.0 mm partially threaded screws.