There are several techniques to fix the greater tuberosity. The choice depends on
Size of the fragment
Bone quality (osteoporosis)
Degree of fragmentation
A) Screw fixation (cannulated or standard screws; with or without washers)
This is mainly indicated for single large fragment with good bone quality.
B) Tension band sutures
Tension band sutures are more secure for patients with osteoporosis or comminution because they can be placed through tendon insertion sites, which may be stronger than the bone itself. The sutures can be placed in patterns that are optimal for stabilizing comminuted fractures.
Distal anchorage of tension band sutures can be through an anterior to posterior drill hole in the humerus (B1), to screws (B2), through suture anchors, or through the lateral cortex of the humerus just distal to the fracture site. Combinations of these techniques are possible.