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Effect of Lesser Tuberosity Osteotomy Size and Repair Construct During Total Shoulder Arthroplasty

Brown, Brandon (2013) Effect of Lesser Tuberosity Osteotomy Size and Repair Construct During Total Shoulder Arthroplasty. Master's Thesis, University of Pittsburgh. (Unpublished)

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Background. Lesser tuberosity osteotomy has been shown to decrease post-operative subscapularis dysfunction. The purpose of this study was to determine the effect of osteotomy thickness and suture configuration on repair integrity.

Methods. One side of twelve matched-pair cadaveric shoulders was randomly assigned either a thick osteotomy (100% lesser tuberosity height) or a thin (50% height) osteotomy. Both sides of the matched-pairs were given the same repair, either 1) compression-sutures or 2) compression-sutures plus one tension-suture. This created four groups of six paired specimens. CT imaging measured tuberosity dimensions pre- and post-osteotomy to validate fragment height and area. The repairs were loaded cyclically and then loaded to failure. A video system measured fragment displacement. Percent area of osteotomy contact was calculated from the CT and displacement data.

Results. The average initial displacement was less in the thin osteotomy groups (p=0.011). Adding a tension-suture negated this difference. A significant number of thin compared to thick repair sites remained intact during load to failure (p=0.001). No difference occurred due to maximal load between the repair groups (p=0.40) and construct stiffness was greater when a tension-suture was used (p=0.032). Percent area of osteotomy contact revealed no differences between the osteotomy (p=0.431) and repair (p=0.25) groups.

Conclusion. The study showed that thin osteotomies displaced less than thick osteotomies. Adding a tension band improved construct stability and eliminated some failure modes. The ideal repair was a thin wafer with both tension and compression sutures. This construct had smaller total displacement, a reasonable osteotomy percent contact area, and acceptable maximum load.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Brown, Brandonbrb102@pitt.eduBRB102
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee MemberVipperman, Jeffreyjsv@pitt.eduJSV
Committee MemberSmolinski, Patrickpatsmol@pitt.eduPATSMOL
Committee MemberZhang, Xudongxuz9@pitt.eduXUZ9
Thesis AdvisorMiller,
Date: 27 June 2013
Date Type: Publication
Defense Date: 1 April 2013
Approval Date: 27 June 2013
Submission Date: 5 April 2013
Access Restriction: No restriction; Release the ETD for access worldwide immediately.
Number of Pages: 104
Institution: University of Pittsburgh
Schools and Programs: Swanson School of Engineering > Mechanical Engineering
Degree: MS - Master of Science
Thesis Type: Master's Thesis
Refereed: Yes
Uncontrolled Keywords: Total Shoulder Arthroplasty, subscapularis repair, lesser tuberosity osteotomy repair, lesser tuberosity osteotomy thickness, tension-band sutures, compression sutures, biomechanics.
Date Deposited: 27 Jun 2013 15:18
Last Modified: 15 Nov 2016 14:11


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