Surgical Discussion

Patient positioning:  The patient was positioned in a beach chair position to facilitate optimal access to the shoulder joint.

Anatomical surgical approach:  A transdeltoid approach was utilized, involving an incision through the deltoid muscle to expose the greater tuberosity. Sutures were passed through the supraspinatus and infraspinatus tendons to aid in the reduction of the fracture. The fragment was temporarily fixed with a Kirschner wire, and reduction was verified. Definitive fixation was achieved using a cancellous screw and transosseous sutures.

The reduction of the greater tuberosity fragment was confirmed intraoperatively. The use of both a Kirschner wire for temporary stabilization and a cancellous screw for definitive fixation ensured adequate stability of the fracture. Transosseous sutures provided additional support to maintain the reduction.

Postoperative protocol:   Postoperative rehabilitation included immobilization of the shoulder in a sling for 4 weeks, followed by passive range of motion exercises. Active range of motion exercises were initiated at 6 weeks postoperatively, with gradual progression to strengthening exercises by 12 weeks.

Follow up:   Not specified

Orthopaedic implants used:   - Kirschner wire - Cancellous screw - Transosseous sutures