Review Question - QID 217831

The patient has an isolated displaced greater tuberosity (GT) fracture. If treated nonoperatively, impingement with loss of abduction would likely result.

Isolated greater tuberosity fractures may be associated with glenohumeral dislocations. Minimally displaced greater tuberosity fractures can be treated nonoperatively. Displaced fractures may result in impingement with loss of abduction and external rotation. Operative treatment is indicated for fractures displaced more than 5 mm in the general population and >3 mm of displacement in overhead athletes. Surgical repair can be done with suture, suture anchors, or screw fixation.

Mattyasovzky et al. retrospectively reviewed 30 patients with an isolated greater tuberosity fracture. The authors noted that minimally displaced fractures (<5 mm) and displaced fractures (>5 mm) were treated successfully with nonoperative and operative treatment, respectively. The most common complication was impingement syndrome.

Platzer et al. retrospectively reviewed 135 patients with a minimally displaced (1-5 mm) greater tuberosity fracture who were treated nonoperatively. Female and younger patients had significantly better outcomes. 97% of the patients had good or excellent results and the authors concluded that minimally displaced fractures can be treated nonoperatively.

Figure A is an AP radiographs demonstrating an isolated displaced greater tuberosity fracture.

Incorrect Answers
Answer 1: Displacement of the greater tuberosity would impair the function of the rotator cuff. Furthermore, recurrent shoulder instability is more of a concern in younger patients.
Answer 3: Due to attachment of the supraspinatus, infraspinatus and teres minor on to the greater tuberosity, abduction and external rotation would be affected more than internal rotation.
Answer 4 and 5: Isolated GT fractures are not associated with AVN or post-traumatic arthritis.