Modified Hook Wiring Technique for Greater Tuberosity Fractures: A Prospective Study

Abstract

Managing greater tuberosity (GT) fractures, especially those with glenohumeral (GH) dislocations, poses a challenge in balancing stable fixation while promoting early mobilization. While surgical fixation is often required for significant displacement, the optimal fixation technique remains debated due to the risk of complications and inconsistent outcomes. This study aimed to evaluate the outcomes of the Modified Hook Wiring (MHW) technique for open reduction and internal fixation of isolated displaced GT fractures. Thirteen patients with a mean age of 49.4±4.7 years were treated using the MHW technique, with 84.6% presenting concomitant GH dislocations. The mean follow-up was 16±3.3 months. The functional evaluation using the Constant-Murley and ASES scores yielded averages of 77.9±16.9 and 83.1±19.6 at one year, with no relevant changes at the final follow-up. The average range of motion showed forward flexion of 148°±31° and abduction of 142.3°±26.2°. The mean subjective shoulder value reached 81.5%±13.6%, while the mean visual analog scale score was 1.46±1.7. Radiographic analysis confirmed complete fracture healing in all cases by 9.7±1.3 weeks, with no evidence of displacement or malunion. Two patients (15.3%) experienced postoperative stiffness, and one developed a superficial wound infection. The results suggest that the MHW technique offers stable fixation, reliable union, and satisfactory shoulder function, making it a promising alternative for treating displaced GT fractures, particularly in the setting of GH dislocation. Its facilitation of early shoulder mobilization and low complication profile highlight potential benefits over conventional fixation methods. This study provides Level IV evidence. Trial registration: NCT05403879.