Do minimally displaced (≤3 mm) greater tuberosity fractures always heal uneventfully? A one-year retrospective analysis

Süleyman Kaan Öner; Serkan Tiryakioğlu; Bilgehan Ocak; Enes Alptekin Canlı; Süleyman Kozlu; Nihat Demirhan Demirkıran

Do minimally displaced (≤3 mm) greater tuberosity fractures always heal uneventfully? A one-year retrospective analysis

Abstract

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.

Keywords

Supporting Institution

This study received no financial or institutional support.

Ethical Statement

The study was approved by the Ethics Committee of Kütahya Health Sciences University (approval date: February 9, 2026; decision no: 2026/02-28) and was conducted in accordance with the Declaration of Helsinki. Due to the retrospective design of the study, the requirement for informed consent was waived.

Thanks

Not applicable

References

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
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
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
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
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
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
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
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

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
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
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
Warner JJP, Higgins L, Parsons IM, Dowdy P. Diagnosis and treatment of anterosuperior rotator cuff tears. Clin Orthop Relat Res. 2001;(390):64-74
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
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
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
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
Neer CS. Displaced proximal humeral fractures. I. Classification and evaluation. J Bone Joint Surg Am. 1970;52(6):1077-1089.
Bigliani LU, Flatow EL, McCluskey GM. Fractures of the proximal humerus. Instr Course Lect. 1992;41:199-206.
Flatow EL. Fractures of the proximal humerus. Instr Course Lect. 1997; 46:37-46.
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.
Kim SH, Ha KI, Park JH, et al. Arthroscopic treatment of shoulder stiffness. J Bone Joint Surg Am. 2004;86(7):151-158.
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.
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
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

Details

Primary Language

English

Subjects

Orthopaedics

Journal Section

Research Article

Authors

Süleyman Kaan Öner
0000-0002-4333-0582
Türkiye

Serkan Tiryakioğlu
0000-0002-5883-285X
Türkiye

Bilgehan Ocak ^*
0000-0001-7930-0775
Türkiye

Enes Alptekin Canlı
0000-0003-3547-1139
Türkiye

Süleyman Kozlu This is me
0000-0001-5175-0600
Türkiye

Nihat Demirhan Demirkıran
0000-0002-0724-9672
Türkiye

Publication Date

May 19, 2026

Submission Date

March 20, 2026

Acceptance Date

April 20, 2026

Published in Issue

Year 2026 Volume: 9 Number: 3

IZ

https://izlik.org/JA82SX36NY

Cite

RIS / Bibtex

APA

Öner, S. K., Tiryakioğlu, S., Ocak, B., Canlı, E. A., Kozlu, S., & Demirkıran, N. D. (2026). Do minimally displaced (≤3 mm) greater tuberosity fractures always heal uneventfully? A one-year retrospective analysis. Journal of Health Sciences and Medicine, 9(3), 793-798. https://izlik.org/JA82SX36NY

AMA

1.Öner SK, Tiryakioğlu S, Ocak B, Canlı EA, Kozlu S, Demirkıran ND. Do minimally displaced (≤3 mm) greater tuberosity fractures always heal uneventfully? A one-year retrospective analysis. J Health Sci Med / JHSM. 2026;9(3):793-798. https://izlik.org/JA82SX36NY

Chicago

Öner, Süleyman Kaan, Serkan Tiryakioğlu, Bilgehan Ocak, Enes Alptekin Canlı, Süleyman Kozlu, and Nihat Demirhan Demirkıran. 2026. “Do Minimally Displaced (≤3 Mm) Greater Tuberosity Fractures Always Heal Uneventfully? A One-Year Retrospective Analysis”. Journal of Health Sciences and Medicine 9 (3): 793-98. https://izlik.org/JA82SX36NY.

EndNote

Öner SK, Tiryakioğlu S, Ocak B, Canlı EA, Kozlu S, Demirkıran ND (May 1, 2026) Do minimally displaced (≤3 mm) greater tuberosity fractures always heal uneventfully? A one-year retrospective analysis. Journal of Health Sciences and Medicine 9 3 793–798.

IEEE

[1]S. K. Öner, S. Tiryakioğlu, B. Ocak, E. A. Canlı, S. Kozlu, and N. D. Demirkıran, “Do minimally displaced (≤3 mm) greater tuberosity fractures always heal uneventfully? A one-year retrospective analysis”, J Health Sci Med / JHSM, vol. 9, no. 3, pp. 793–798, May 2026, [Online]. Available: https://izlik.org/JA82SX36NY

ISNAD

Öner, Süleyman Kaan - Tiryakioğlu, Serkan - Ocak, Bilgehan - Canlı, Enes Alptekin - Kozlu, Süleyman - Demirkıran, Nihat Demirhan. “Do Minimally Displaced (≤3 Mm) Greater Tuberosity Fractures Always Heal Uneventfully? A One-Year Retrospective Analysis”. Journal of Health Sciences and Medicine 9/3 (May 1, 2026): 793-798. https://izlik.org/JA82SX36NY.

JAMA

1.Öner SK, Tiryakioğlu S, Ocak B, Canlı EA, Kozlu S, Demirkıran ND. Do minimally displaced (≤3 mm) greater tuberosity fractures always heal uneventfully? A one-year retrospective analysis. J Health Sci Med / JHSM. 2026;9:793–798.

MLA

Öner, Süleyman Kaan, et al. “Do Minimally Displaced (≤3 Mm) Greater Tuberosity Fractures Always Heal Uneventfully? A One-Year Retrospective Analysis”. Journal of Health Sciences and Medicine, vol. 9, no. 3, May 2026, pp. 793-8, https://izlik.org/JA82SX36NY.

Vancouver

1.Süleyman Kaan Öner, Serkan Tiryakioğlu, Bilgehan Ocak, Enes Alptekin Canlı, Süleyman Kozlu, Nihat Demirhan Demirkıran. Do minimally displaced (≤3 mm) greater tuberosity fractures always heal uneventfully? A one-year retrospective analysis. J Health Sci Med / JHSM [Internet]. 2026 May 1;9(3):793-8. Available from: https://izlik.org/JA82SX36NY