JHSM

Journal of Health Sciences and Medicine (JHSM) is an unbiased, peer-reviewed, and open access international medical journal. The Journal publishes interesting clinical and experimental research conducted in all fields of medicine, interesting case reports, and clinical images, invited reviews, editorials, letters, comments, and related knowledge.

EndNote Style
Index
Original Article
Do minimally displaced (?3 mm) greater tuberosity fractures always heal uneventfully? A one-year retrospective analysis
Aims: To evaluate the one-year outcomes of conservatively treated isolated greater tuberosity fractures with minimal initial displacement, with particular emphasis on secondary surgical intervention, magnetic resonance imaging (MRI) findings, and the course of bone marrow edema (BME).
Methods: This retrospective cohort study included 43 adult patients with isolated greater tuberosity fractures presenting between 2018 and 2023, all of whom had an initial displacement of ?3 mm and were managed conservatively. Clinical and radiographic data were reviewed with a minimum follow-up of 12 months. The primary outcome was the need for secondary surgical intervention within one year. Secondary outcomes included MRI-detected concomitant soft-tissue pathology, time to BME regression on serial MRI, and final Constant-Murley score.
Results: The mean patient age was 52.6±13.4 years, and 26 patients (60.5%) were female. During follow-up, 5 patients (11.6%) required secondary surgical intervention, all of which were arthroscopic procedures. No patient required secondary bony fixation or corrective surgery, and no cases of nonunion, malunion, or secondary displacement were observed. MRI was performed in 18 patients (41.9%) because of persistent symptoms or delayed recovery, and 12 of these patients (66.7%) demonstrated at least one concomitant soft-tissue pathology. All imaged patients who later required secondary surgery had at least one associated soft-tissue lesion. Serial MRI evaluation was available in 11 patients, with a median time to BME regression of 15 weeks (interquartile range, 12-20 weeks). The mean Constant-Murley score at 12 months was 81.4±9.6 and was lower in patients who required secondary surgery.
Conclusion: Although minimally displaced greater tuberosity fractures are generally considered to have a benign clinical course, a subset of patients may develop persistent symptoms requiring secondary arthroscopic intervention. In these cases, associated soft-tissue pathology and prolonged bone marrow edema appear to be important determinants of outcome than fracture displacement.


1. Platzer P, Kutscha-Lissberg F, Lehr S, et al. The influence of displacement on shoulder function in patients with minimally displaced fractures of the greater tuberosity. Injury. 2005;36(10):1185-1189. doi:10.1016/j.injury.2005.02.004
2. Park TS, Choi IY, Kim YH, et al. Greater tuberosity fracture of the humerus: displacement and treatment outcome. J Shoulder Elbow Surg. 2011;20(7):1090-1096. doi:10.1016/j.jse.2011.01.019
3. Mattyasovszky SG, Burkhart KJ, Ahlers C, et al. Isolated fractures of the greater tuberosity of the proximal humerus: a long-term retrospective study of 30 patients. Acta Orthop. 2011;82(6):714-720. doi:10.3109/17453674.2011.618912
4. Schliemann B, Siemoneit J, Theisen C, et al. Isolated fractures of the greater tuberosity: when are they treated conservatively? Arch Orthop Trauma Surg. 2018;138(4):483-491. doi:10.1007/s00402-018-2887-1
5. Platzer P, Thalhammer G, Oberleitner G, et al. Displaced fractures of the greater tuberosity: a comparison of operative and nonoperative treatment. J Trauma. 2008;65(4):843-848. doi:10.1097/TA.0b013e31818 48e35
6. Rath E, Levy O, Even T, et al. Minimally displaced fractures of the greater tuberosity: outcome of non-operative treatment. J Shoulder Elbow Surg. 2013;22(9):e8-e11. doi:10.1016/j.jse.2013.03.008
7. White EA, Skalski MR, Patel DB, et al. Isolated greater tuberosity fractures of the proximal humerus: anatomy, injury patterns, and imaging review. Radiographics. 2018;38(2):424-438. doi:10.1148/rg. 2018170104
8. Zanetti M, Bruder E, Romero J, et al. Bone marrow edema pattern in the greater tuberosity: correlation with rotator cuff tears. AJR Am J Roentgenol. 2000;175(4):1099-1104. doi:10.2214/ajr.175.4.1751099
9. Roemer FW, Bohndorf K. Long-term osseous sequelae after acute trauma of the shoulder. Skeletal Radiol. 2002;31(11):615-623. doi:10.1007/s00256-002-0543-5
10. Patel AH, Yoon RS, Liporace FA, et al. Short-term reoperation risk after surgical and nonsurgical management of isolated greater tuberosity fractures. JSES Int. 2021;5(3):398-404. doi:10.1016/j.jseint.2021.01.006
11. Keener JD, Steger-May K, Stobbs G, et al. Relationship between greater tuberosity fractures and rotator cuff injury. J Shoulder Elbow Surg. 2014; 23(9):e73-e79. doi:10.1016/j.jse.2014.02.010
12. Warner JJP, Higgins L, Parsons IM, Dowdy P. Diagnosis and treatment of anterosuperior rotator cuff tears. Clin Orthop Relat Res. 2001;(390):64-74
13. Lädermann A, Denard PJ, Collin P. Massive rotator cuff tears: definition and treatment. Int Orthop. 2015;39(12):2403-2414. doi:10.1007/s00264-015-2796-1
14. Hofmann S, Kramer J, Vakil-Adli A, et al. Bone marrow edema syndrome. Orthop Clin North Am. 2004;35(3):321-329. doi:10.1016/j.ocl. 2004.02.004
15. Zanetti M, Bruder E, Romero J, Hodler J. Bone marrow edema pattern: MR imaging. Radiology. 2000;215(3):835-842. doi:10.1148/radiology.215.3.r00jn01835
16. Mandalia V, Henson JH, Traill MR, et al. Bone bruising of the shoulder. Skeletal Radiol. 2005;34(10):593-601. doi:10.1007/s00256-005-0942-6
17. Neer CS. Displaced proximal humeral fractures. I. Classification and evaluation. J Bone Joint Surg Am. 1970;52(6):1077-1089.
18. Bigliani LU, Flatow EL, McCluskey GM. Fractures of the proximal humerus. Instr Course Lect. 1992;41:199-206.
19. Flatow EL. Fractures of the proximal humerus. Instr Course Lect. 1997; 46:37-46.
20. Harryman DT, Sidles JA, Harris SL, Matsen FA. The role of the rotator interval capsule in passive motion of the shoulder. J Bone Joint Surg Am. 1992;74(1):53-66.
21. Kim SH, Ha KI, Park JH, et al. Arthroscopic treatment of shoulder stiffness. J Bone Joint Surg Am. 2004;86(7):151-158.
22. Gerber C, Schneeberger AG, Hoppeler H, Meyer DC. Correlation of atrophy and fatty infiltration on magnetic resonance imaging with shoulder strength and integrity of the rotator cuff. J Bone Joint Surg Am. 2000;82(4):505-515.
23. Gumina S, Candela V, Passaretti D, et al. The association between greater tuberosity fractures and subacromial impingement syndrome. Injury. 2009;40(11):1195-1199. doi:10.1016/j.injury.2009.05.018
24. Murray IR, Benke MT, Mandelbaum BR. Management of bone-tendon junction injuries. J Orthop Res. 2013;31(9):1421-1429. doi:10.1002/jor. 22367
Volume 9, Issue 3, 2026
Page : 793-798
_Footer