{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,7]],"date-time":"2026-02-07T11:38:03Z","timestamp":1770464283378,"version":"3.49.0"},"reference-count":14,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2022,11,4]],"date-time":"2022-11-04T00:00:00Z","timestamp":1667520000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Orthopaedic Surgery"],"published-print":{"date-parts":[[2023,8]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Greater tuberosity (GT) fragments were communicated, and additional techniques to increase the GT fragment stability after the locking plate fixation was necessary. This study aimed to analyze the reinforcement effects on the anterior\u2010avulsion GT fragment in Neer three\u2010part proximal humeral fractures (PHFs) using transosseous suture and suture anchor techniques.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Eighteen fresh\u2010frozen human cadaveric shoulder specimens were used in the study. Standardized fracture of the GT and surgical neck was created in 18 human cadaveric proximal humerus. The GT fragments were reinforced with transosseous suture (TS), suture anchor (SA), and suture in addition to the PHILOS plate fixation. The fixed humerus was tested by applying static loading to the supraspinatus tendon. Load forces and fragment displacement were evaluated by a biomechanical testing machine, and the load to 3\u2010 and 5\u2010mm displacements, load to failure, and mode of failure were recorded for all specimens. Nonparametric variables were examined by the Kruskal\u2013Wallis test, and the Bonferroni <jats:italic>post hoc<\/jats:italic> test was used to analyze the mean loads to create 3\u2010 and 5\u2010mm displacements as well as the failure load.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The age, female proportion, and bone mineral density showed no statistically significant differences between the three groups. The mean loading force to create 3\u2010mm and 5\u2010mm displacement in the TS group (254.9\u2009\u00b1\u200977.4, 309.6\u2009\u00b1\u2009152.7) were significantly higher than those in the suture group (136.1\u2009\u00b1\u200916.7, 193.4\u2009\u00b1\u200914.5) (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.024, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.005). For the SA group, the force to create 3\u2010 and 5\u2010mm displacement (204.3\u2009\u00b1\u200960.9, 307.8\u2009\u00b1\u200973.5) were comparable to those in the TS group (<jats:italic>P<\/jats:italic> =\u20090.236, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.983). Moreover, the loading force to failure in the TS group (508.6\u2009\u00b1\u2009217.7) and SA group (406.6\u2009\u00b1\u2009114.9) was significantly higher than that in the suture group (265.9\u2009\u00b1\u200952.1) (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.021, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.024). In the TS group, three failed due to tendon\u2010bone junction rupture; bone tunnel broken occurred in two specimens; suture rupture could also be seen in one specimen. All specimens in the suture group failed because of suture rupture. In the SA group, three specimens failed due to suture rupture; two failed secondary to tendon\u2010bone junction rupture; and one failed because of shaft fracture.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Transosseous suture is a new type of reinforcement for GT fragment in Neer\u2010three part PHFs. The transosseous suture was superior to the suture only in the reinforcement of the anterior\u2010avulsion GT fragment of Neer three\u2010part PHFs, and it had comparable biomechanical strength to the suture anchor.<\/jats:p><\/jats:sec>","DOI":"10.1111\/os.13536","type":"journal-article","created":{"date-parts":[[2022,11,4]],"date-time":"2022-11-04T12:07:21Z","timestamp":1667563641000},"page":"2132-2137","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["A Transosseous Suture as an Alternative to Suture Anchor on Anterior\u2010Avulsion Greater Tuberosity Fragment Fixation in Neer Three\u2010Part Proximal Humeral Fracture: A Biomechanical Study"],"prefix":"10.1111","volume":"15","author":[{"given":"Jiabao","family":"Ju","sequence":"first","affiliation":[{"name":"Department of Trauma &amp; Orthopaedics Peking University People's Hospital  Beijing China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mingtai","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Trauma &amp; Orthopaedics Peking University People's Hospital  Beijing China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhentao","family":"Ding","sequence":"additional","affiliation":[{"name":"Department of Trauma &amp; Orthopaedics Peking University People's Hospital  Beijing China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0677-7203","authenticated-orcid":false,"given":"Yichong","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Trauma &amp; Orthopaedics Peking University People's Hospital  Beijing China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhongguo","family":"Fu","sequence":"additional","affiliation":[{"name":"Department of Trauma &amp; Orthopaedics Peking University People's Hospital  Beijing China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2223-783X","authenticated-orcid":false,"given":"Jianhai","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Trauma &amp; Orthopaedics Peking University People's Hospital  Beijing China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2022,11,4]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.5435\/JAAOS-D-14-00289"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jse.2017.11.029"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.H.00133"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.L.01293"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/BOT.0000000000000575"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00590-020-02835-8"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2009.09.011"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2015.02.007"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620x.83b7.10516"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12891-017-1868-7"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.21037\/atm-20-1065"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1177\/0363546521998318"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12891-019-2412-8"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jse.2014.09.032"}],"container-title":["Orthopaedic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/os.13536","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/os.13536","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/os.13536","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,20]],"date-time":"2023-08-20T21:24:50Z","timestamp":1692566690000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/os.13536"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,11,4]]},"references-count":14,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2023,8]]}},"alternative-id":["10.1111\/os.13536"],"URL":"https:\/\/doi.org\/10.1111\/os.13536","archive":["Portico"],"relation":{},"ISSN":["1757-7853","1757-7861"],"issn-type":[{"value":"1757-7853","type":"print"},{"value":"1757-7861","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,11,4]]},"assertion":[{"value":"2022-06-25","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-09-08","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-11-04","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}