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4Plate fixation

Additional tension band suture

Tension band sutures in addition to plate and screws

Supplementary rotator cuff tendon sutures provide additional stability. Varying the arm position helps to place them through such a small incision. The sutures should be inserted close to the bony insertion sites of subscapularis, supraspinatus, and infraspinatus tendons. They are tied to the plate to resist muscle forces and improve plate anchorage.