The Analysis Of The Risk Factors Related To Rotator Cuff Tears In Isolated Greater Tuberosity Fractures

Objective: To explore the risk factors of rotator cuff tears in isolated fractures of the greater tuberosity.Methods: A retrospective analysis was made of the data of 124 patients with acute isolated fractures of the greater tuberosity from from August 2017 to August 2019.There were 53 males and 71 females,aged 20-90 years,with an average age of 51.73 years.All the patients performed the X-ray examination of anteroposterior view and scapular Y view,and also the MRI examination.According to the imaging data,the fracture classification,displacement,acromion classification,critical shoulder angle(CSA),the quality rotator cuff tendon were evaluated.According to whether the rotator cuff tear and whether the rotator cuff tear exceeded 50% of the thickness,they were divided into 2 groups.The risk factors were screened by univariate analysis of age,gender,dominant hand,smoking and drinking history,diabetes/hypertension,dislocation,CSA,fracture classification of greater tuberosity and displacement,and then multivariate factors were used.Logistic regression analysis identified the main independent risk factors,P < 0.05 that the difference was statistically significant.Results: Of all the patients,84 patients had rotator cuff tears,with an incidence of 67.7%.Among the rotator cuff tears,there were 51 cases with<50% thickness,accounting for 60.7%(51/84),and 4 cases with rotator cuff fullthickness tears,accounting for 4.7%(4/84).The energy associated with the injury mechanism was inversely related with age,with the most frequent being fall from standing(61.3%;mean age,54.4 years),fall from high than standing height(12.9%,mean age,55.0 years),Injured while cycling(13.7%,mean age,49.9 years)sporting activity(6.5%;mean age,34.1 years),and vehicular trauma(5.6%;mean age,39.8 years).Univariate analysis showed that age,dislocation,fracture classification,comminution,quality of rotator cuff tendon,displacement of greater tuberosity on MRI were the risk factors of rotator cuff tears(P<0.05).Logistic regression analysis showed that dislocation(OR=0.281,95% CI:0.084-0.938),fracture classification(OR=4.096,95% CI:1.094-15.33),quality of rotator cuff tendon(OR=6.69,95% CI:1.343-33.315)were independent risk factors for rotator cuff tears in isolated fractures of the greater tuberosity.And in the group of whether rotator cuff tear exceeded 50% of the thickness,age,dislocation,drinking,diabetes,hypertension,fracture classification,comminution,quality of rotator cuff tendon,displacement of greater tuberosity on X-ray and MRI were the risk factors of rotator cuff tears exceeded 50% of the thickness(P<0.05).Logistic regression analysis showed that fracture classification(OR=15.683,95% CI:1.851-132.879),quality of rotator cuff tendon(OR=6.188,95% CI:1.28-29.91)were independent risk factors for rotator cuff tears exceeded 50% of the thickness in isolated greater tuberosity fractures.Conclusion: Isolated greater tuberosity fractures often combined with rotator cuff tears.The energy associated with the injury mechanism was inversely related with age.Isolated greater tuberosity fractures combined with rotator cuff tears were related to the factors of old age,dislocation,fracture classification,comminution of greater tuberosity and poor quality of rotator cuff tendon.Poor quality of rotator cuff tendon and split fracture of greater tuberosity are independent risk factors of rotator cuff tears exceeded 50% of the thickness.