Treatment for Nondisplaced Greater Tuberosity Fracture
Most proximal humeral fractures, including nondisplaced greater tuberosity fractures, can be treated non-operatively with good functional outcomes. 1
Non-operative Management
Non-operative management is the recommended first-line treatment for nondisplaced greater tuberosity fractures and includes:
- Initial immobilization with a sling for comfort and pain control 2
- Early rehabilitation program starting approximately one week after injury 2
- Physical therapy focusing on:
- Analgesic modalities for pain control
- Progressive range of motion exercises
- Strengthening exercises
- Proprioceptive stabilization exercises 2
Indications for Surgical Management
Surgery should be considered in the following situations:
- Displacement of 3-5 mm or more, especially in active patients, as this can adversely affect rotator cuff biomechanics and lead to subacromial impingement 3
- Secondary displacement during conservative treatment, which occurs in approximately 16% of cases overall and up to 26% in patients under 70 years 4
- Patients with high functional demands where even minimal displacement could impact performance 5
Surgical Options
When surgery is indicated, options include:
- Open reduction and internal fixation using:
- Suture anchors
- Transosseous sutures
- Tension bands
- Plates/screws 3
- Arthroscopic techniques:
- Transosseous augmented fixation for displaced fractures 6
Monitoring and Follow-up
- Regular radiographic follow-up is essential to detect potential displacement during conservative treatment 4
- Rehabilitation should continue after fracture healing with a program similar to that used for rotator cuff disease 2
Outcomes and Prognosis
- Non-operative treatment of properly selected cases shows good functional outcomes 1, 2
- Surgical treatment for displaced fractures is associated with high patient satisfaction and low complication rates 5
- Poorer functional outcomes are associated with:
Important Considerations
- Careful monitoring is required during conservative treatment as migration of initially well-reduced fractures can occur in up to 16% of cases 4
- Concomitant anterior glenohumeral instability is present in approximately 28% of greater tuberosity fractures and is significantly more common in displaced fractures (44.3%) compared to nondisplaced fractures (14.5%) 5
- When comparing surgical techniques, screw fixation is associated with lower rates of shoulder stiffness (0% vs 12.0%) and reoperation (0% vs 8.0%) compared to suture constructs 5