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Conservative treatment of displaced isolated proximal humerus greater tuberosity fractures: preliminary results of a prospective, CT-based registry study

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

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.

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Data availability

The manuscript has associated data in a data repository.

Code availability

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Acknowledgements

The authors would like to thank all the participating patients, physiotherapists, the study nurses Mrs. Greeske and Arens, our data manager Mr. Tim Licker, the secretaries Mrs. Assaid and Karataban and the whole trauma team of the Hannover Medical School, Germany. Furthermore, we would like to thank our inhouse Traumastiftung gGmbH as a collaborator enabling this study.

Funding

This study was funded by our inhouse Traumastiftung gGmbH.

Author information

Authors and Affiliations

  1. Trauma Department, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hanover, Germany

    Sam Razaeian, Nael Hawi, Emmanouil Liodakis & Christian Krettek

  2. Department of Orthopaedic Surgery, Brigham and Women’s Hospital, 75 Francis St, Boston, MA, 02115, USA

    Dafang Zhang

Authors
  1. Sam Razaeian
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  2. Nael Hawi
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  4. Emmanouil Liodakis
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Corresponding author

Correspondence to Sam Razaeian.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study is authorized by the local ethical committee as part of an observational registry study (Hannover Humerus Registry—HHR) (journalno. 322-2016) and was carried out in accordance with the Ethical standards of the 1964 Declaration of Helsinki as updated in 2004.

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All patients gave written informed consent.

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Razaeian, S., Hawi, N., Zhang, D. et al. Conservative treatment of displaced isolated proximal humerus greater tuberosity fractures: preliminary results of a prospective, CT-based registry study. Eur J Trauma Emerg Surg 48, 4531–4543 (2022). https://doi.org/10.1007/s00068-020-01453-7

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  • DOI: https://doi.org/10.1007/s00068-020-01453-7

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