Arthroscopic Proximal Humerus Greater Tuberosity Fracture Repair is a technique developed by Dr. Chudik that addresses displaced tuberosity fractures of the upper arm bone through small arthroscopic incisions. The procedure repairs fractures that are conventionally treated with open surgery, preserving the surrounding soft tissues and supporting faster recovery. Dr. Chudik developed and routinely performs the technique for both greater and lesser tuberosity fractures, often combined with treatment of associated rotator cuff or labral injury at the same procedure.
What Is Arthroscopic Greater Tuberosity Fracture Repair?
The greater and lesser tuberosities are bony prominences of the proximal humerus (upper arm bone) that serve as the attachment sites for the rotator cuff muscles. The greater tuberosity anchors the supraspinatus, infraspinatus, and teres minor; the lesser tuberosity anchors the subscapularis. Both can fracture and separate from the rest of the humerus during falls, dislocations, and other shoulder injuries.
Displaced tuberosity fractures separate the rotator cuff insertion away from the humerus and disrupt shoulder function. Surgical repair re-positions the bone fragments and reconnects the rotator cuff insertions, restoring the mechanics that allow the cuff to lift and rotate the arm. Mildly displaced fractures can be treated non-operatively. Significantly displaced fractures require surgery to restore tuberosity position and rotator cuff continuity.
Dr. Chudik developed an arthroscopic technique that addresses the most common displaced tuberosity fracture pattern through small portals, where conventional treatment requires open surgery and a larger soft-tissue exposure.
Development Rationale
The standard surgical approach for displaced tuberosity fractures has historically been open reduction with plate or suture fixation through a deltopectoral or transdeltoid incision. The open exposure provides direct visualization of the fragment but disrupts the surrounding soft tissues, including portions of the deltoid, and creates a longer recovery before active motion is permitted. Open surgery also makes it more difficult to identify and treat associated intra-articular pathology (labral tears, biceps disease, additional rotator cuff tearing) that often accompanies the fracture.
Dr. Chudik developed the arthroscopic approach to:
- Repair displaced tuberosity fractures through small portals rather than open exposure
- Inspect the joint and treat associated intra-articular pathology in the same procedure
- Use the least invasive fixation method (sutures, anchors, screws, or plate) appropriate to the specific fracture
- Preserve the deltoid attachment and surrounding soft tissues
- Allow earlier motion and return to function
The technique is supported by intraoperative fluoroscopy to confirm fracture reduction.
Who Is a Candidate?
Candidates typically have:
- A displaced greater or lesser tuberosity fracture documented on X-ray and MRI
- Loss of shoulder function from disruption of the rotator cuff insertion
- Active patients who require restored shoulder mechanics for work, sport, or daily activity
- A medical profile that allows safe surgery
- A fracture pattern amenable to arthroscopic reduction and fixation
Mildly displaced fractures and fractures in patients with poor general health are typically managed without surgery.
Contraindications include infection and patients with health unable to safely proceed with surgery.
How the Procedure Is Performed
The procedure is performed as outpatient surgery through small arthroscopic portals. After a diagnostic arthroscopic survey of the joint to identify and address any associated labral or rotator cuff pathology, the displaced tuberosity is mobilized to its anatomic position.
Fixation is selected based on the specific fracture pattern. Dr. Chudik’s approach uses the least invasive method that achieves stable reduction:
- Sutures alone for stable reductions
- Suture anchors when bone-to-tendon fixation is needed
- Cannulated screws for larger displaced fragments
- A small plate when greater stability is required
Live intraoperative X-ray (fluoroscopy) confirms anatomic alignment of the bone fragments before final fixation. Concomitant labral or rotator cuff tears are treated through the same arthroscopic portals.
The shoulder is placed in a sling at the end of the procedure, and bone healing typically requires approximately six weeks of immobilization.
Recovery and Rehabilitation
Recovery follows a protected protocol:
- Sling at all times for six weeks except for bathing, dressing, and exercises (this prohibits driving)
- No active movement of the repaired shoulder, and possibly the elbow if the biceps tendon is involved, for at least six weeks while the bone heals
- Sleeping upright on a couch or recliner is often more comfortable
- Wound care: clean and dry for three days for arthroscopic surgery; light showering after three days; no submersion under water for three weeks
- Driving typically resumes at six to eight weeks
- Return to school or sedentary work in one to two weeks while in the sling
- Physical therapy begins two to three days after surgery and continues for four to six months
Return to unlimited activity requires complete pain resolution, full shoulder range of motion, restored muscle strength and endurance, and functional use. This typically requires four to six months. Dr. Chudik has specific protocols for return to throwing and golf.
Risks and Outcomes
Specific surgical risks include:
- Infection
- Nerve injury (numbness, weakness, paralysis) of the shoulder and arm, particularly when the fracture is associated with a shoulder dislocation
- Continued pain
- Stiffness or loss of motion
- Inability to return to the same level of activity
- Hardware migration or breakage
- Arthritis
- Avascular necrosis (loss of blood supply to the humeral head, which can occur with the fracture itself)
- Nonunion (fracture does not heal)
- Malunion (fracture heals in a poor position)
Outcomes for the arthroscopic technique compare favorably with conventional open repair, with the additional advantage of treating associated intra-articular pathology in the same procedure.
Why Dr. Chudik for Arthroscopic Greater Tuberosity Fracture Repair
Dr. Chudik developed the arthroscopic approach to displaced tuberosity fractures and routinely performs the procedure for both greater and lesser tuberosity patterns. The technique is most useful for active patients who would otherwise face open surgery with a longer recovery and additional soft-tissue disruption. Combined treatment of associated rotator cuff or labral injury in the same procedure further reduces the total surgical burden for patients with combined pathology.