Treatment of Non-Displaced Greater Tuberosity Avulsion Fracture
Non-displaced avulsion fractures of the greater tuberosity should be treated non-operatively with immobilization in a sling for 3 weeks followed by staged rehabilitation, as this approach yields excellent outcomes in 97% of patients 1, 2.
Initial Management
Immobilize the shoulder immediately using a Gilchrist bandage or Mitella sling for 3 weeks 1. This immobilization period allows initial fracture healing while preventing secondary displacement.
Staged Rehabilitation Protocol
The rehabilitation should follow a three-phase approach 2:
Phase 1 (Weeks 0-3):
- Strict immobilization in sling
- No active shoulder movement
Phase 2 (Weeks 3-6):
- Begin pendular exercises
- Progress to active-assisted range of motion exercises
- Focus on gentle mobilization
Phase 3 (Week 6 onwards):
- Initiate active exercises
- Progressive strengthening
- Intensive rehabilitation program
Expected Outcomes and Patient Counseling
Set realistic expectations with patients: Full recovery typically takes an average of 8 months, not weeks 2. The Constant Score improves from approximately 40 points initially to 95 points at final follow-up, with satisfaction scores reaching 9.5 out of 10 2.
Non-operative treatment of minimally displaced fractures (<5 mm) achieves good to excellent results in 97% of cases 1, 3. Even fractures with displacement between 1-5 mm respond well to conservative management without statistically significant differences in outcomes 1.
Monitoring for Complications
Critical pitfall: Secondary displacement can occur, particularly in patients with associated shoulder instability 3. These patients require closer monitoring with repeat radiographs during the first 3-6 weeks.
If chronic pain persists beyond 6 months despite appropriate conservative treatment, consider that a partial-thickness rotator cuff tear on the articular surface may have developed at the fracture site 4. In such cases, MRI evaluation and potential arthroscopic debridement may be warranted.
When Surgery Is NOT Indicated
For truly non-displaced fractures (as specified in your question), surgery is not indicated 3. The threshold for surgical consideration is displacement >5 mm, where rotator cuff biomechanics become compromised, leading to weakness in external rotation and scaption strength, loss of range of motion, and subacromial impingement 3.
Age and Gender Considerations
Female patients achieve significantly better outcomes than males, while patients in their 80s and 90s have significantly worse results compared to younger patients 1. However, this should not alter the treatment approach—non-operative management remains appropriate across all age groups for non-displaced fractures.