Surgical repair of a complete pectoralis major tendon rupture at the humeral insertion has superior results compared to nonoperative
treatment. To our knowledge, a proximal humerus shaft fracture occurring at the site of the bone trough and cortical drill
holes after a pectoralis major tendon rupture repair has not been reported in the literature.
A 45-year-old man sustained an acute left pectoralis major tendon rupture at the humeral insertion while performing a bench
press maneuver. He underwent acute surgical repair. Approximately 8 weeks postoperatively, the patient fell from a standing
height and sustained a proximal humerus shaft fracture through the repair site at the bone trough. Three days after the fracture,
the patient underwent open reduction and internal fixation of the proximal humerus shaft fracture and exploration of the pectoralis
major tendon repair. The fracture was found to be at the level of the repair site, and the pectoralis major tendon was completely
intact to the distal fragment. The fracture healed uneventfully, and the patient regained full motion and strength of his
extremity with no limitations.
Any type of surgical fixation that creates a hole in the humerus or decreases the cross-sectional area such as a bone trough
creates a stress riser. Patients undergoing pectoralis tendon repair that involves violating the humerus with a bone trough
or hole have a slight risk of postoperative humerus fracture, especially if sustaining an early traumatic event such as a
fall.
Drs Silverstein, Goldberg, and Wolin are from the Department of Orthopedics, University of Illinois-Chicago Medical Center,
Chicago, Illinois.
Drs Silverstein, Goldberg, and Wolin have no relevant financial relationships to disclose.
Surgical repair of a complete pectoralis major tendon rupture at the humeral insertion has superior results compared to nonoperative
treatment regarding patient satisfaction, strength, comesis, and return to sport.
1–12
Nonoperative treatment is recommended for proximal, partial, or complete tears in a more sedentary individual.
1–12
Bak et al
2
performed a meta-analysis review of 112 pectoralis tendon ruptures at the humeral insertion and reported 88% good/excellent
results for surgically treated patients compared to 27% nonoperative patients.
Several techniques have been reported for surgical fixation of the pectoralis tendon, including suturing the ruptured tendon
back to the humerus with use of a bone trough and cortical drill holes, suture anchors, screw fixation, direct suture approximation,
and barbed stapling.
3,4,10,12–16
To our knowledge, a proximal humerus shaft fracture occurring at the site of the bone trough and cortical drill holes after
a pectoralis major tendon rupture repair has not been reported in the literature.
A 45-year-old man sustained an acute left pectoralis major tendon rupture while performing a bench press maneuver. The tear
occurred at the humeral insertion. He underwent acute surgical repair as described by Schepsis et al.
4
This technique involves creating a 3- to 5-cm bone trough lateral to the bicipital groove. Using No. 5 nonabsorbable sutures,
2 sets of modified Kessler sutures are used to grasp the muscle and fascia. The sutures are then passed and tied through 4
cortical drill holes made 1 cm lateral to the trough. Any remaining distal tendon is oversewn into the muscle with absorbable
suture.
There were no intraoperative complications, and the patient did well for 8 weeks. Approximately 8 weeks postoperatively, the
patient fell from a standing height and sustained a proximal humerus shaft fracture through the repair site at the bone trough
(Figure ).
Figure 1:. AP (A) and Lateral (B) Radiographs of the Shoulder Showing Oblique Fracture Through the Area of the Bone Trough with Slight
Separation and Widening of the Trough.
Three days after the fracture, the patient underwent open…