Conservative treatment of displaced isolated proximal humerus greater tuberosity fractures: preliminary results of a pro
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ORIGINAL ARTICLE
Conservative treatment of displaced isolated proximal humerus greater tuberosity fractures: preliminary results of a prospective, CT‑based registry study Sam Razaeian1 · Nael Hawi1 · Dafang Zhang2 · Emmanouil Liodakis1 · Christian Krettek1 Received: 17 March 2020 / Accepted: 17 July 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Background Isolated greater tuberosity fractures are uncommon and account for approximately 2-19% [Emerg Radiol. 2018;25(3):235-246] of all proximal humerus fractures. Surgical treatment is the prevailing recommendation in cases of displacement of more than 5 mm for the general healthy population, while conservative treatment is considered to result in inferior outcomes and is not recommended. However, high-grade evidence is lacking for these recommendations. Methods Twenty patients with conservatively treated isolated greater tuberosity fracture were evaluated prospectively as part of a registry study. Morphological Mutch classification, displacement in millimeters, and direction of displacement were determined by computed tomography (CT). Degree of fragment displacement was classified (nondisplaced to minor: ≤ 5 mm; moderate: 6–10 mm; major: > 10 mm). Constant score (CS), age- and sex-adjusted Constant score (adj. CS), subjective shoulder value (SSV), and radiographic follow-up were compared at a minimum follow-up of 12 months. For statistical analysis, quantitative data were compared using Mann–Whitney U t-test. Statistical significance was set at p ≤ 0.05. Results Ninteen patients reached the minimum follow-up at an average of 19 months (range, 12–35 months). 13 patients were women. Average age at the time of injury was 51 years (range, 22–75 years). CS and adj. CS averaged 79 ± 17.5 points, and 91 ± 17.7 points, respectively. The SSV averaged 87 ± 17%. No statistically significant difference in clinical outcomes could be observed with respect to the degree of displacement among the three groups. Conclusion The outcomes of conservatively treated displaced isolated greater tuberosity fractures are underestimated, and current indications for surgical treatment should be questioned. Further studies with larger numbers of patients and longer lengths of follow-up are needed. The protocol of this observational study is registered at ClinicalTrials.gov (NCT03060876). Date of registration: June 8, 2016. Keywords Proximal humerus fracture · Displaced isolated greater tuberosity fracture · Conservative treatment · Greater tuberosity fracture
Introduction
* Sam Razaeian [email protected] Dafang Zhang [email protected] 1
Trauma Department, Hannover Medical School, Carl‑Neuberg‑Str. 1, 30625 Hanover, Germany
Department of Orthopaedic Surgery, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115, USA
2
Isolated greater tuberosity (GT) fractures are uncommon and account for approximately 2-19% [1] of all proximal humerus fractures. In case of greater tuberosity fragment displacement of more than 5 mm, surgical treatment has been
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