Secondary Displacement of Nonsurgically Managed Greater Tuberosity Fractures: Rates, Risk Factors, and Range of Motion

Austin T Gregg; Maaz Muhammad; Carlos R Sierra-Arce; Adam N Musick; Kameron Kraus; Thomas J Policicchio; Robert K Wagner; Derek S Stenquist; Mitchel B Harris; Thuan V Ly; Arun Aneja

doi:10.5435/JAAOS-D-25-00161

Secondary Displacement of Nonsurgically Managed Greater Tuberosity Fractures: Rates, Risk Factors, and Range of Motion

J Am Acad Orthop Surg. 2025 Jun 17. doi: 10.5435/JAAOS-D-25-00161. Online ahead of print.

Authors

Austin T Gregg¹, Maaz Muhammad, Carlos R Sierra-Arce, Adam N Musick, Kameron Kraus, Thomas J Policicchio, Robert K Wagner, Derek S Stenquist, Mitchel B Harris, Thuan V Ly, Arun Aneja

Affiliation

¹ From the Harvard Medical School Orthopaedic Trauma Initiative, Massachusetts General Hospital (Gregg, Muhammad, Sierra-Arce, Musick, Kraus, Policicchio, Wagner, Stenquist, Harris, Ly, and Aneja), and the Department of Orthopaedic Surgery Massachusetts General Hospital, Harvard Medical School, Boston, MA (Gregg, Muhammad, Sierra-Arce, Musick, Kraus, Policicchio, Wagner, Stenquist, Harris, Ly, and Aneja).

PMID: 40549939
DOI: 10.5435/JAAOS-D-25-00161

Abstract

Background: This study evaluated secondary displacement rates for nonsurgically managed greater tuberosity (GT) fractures using a validated radiographic measurement method.

Methods: This retrospective study included adults with GT fractures (AO/OTA 11A1.1) managed nonsurgically between 2010 and 2023 with a minimum radiographic follow-up of 6 weeks at two level 1 trauma centers. The primary outcome was the rate of secondary displacement, defined as a superior GT position (GT ratio ≥ 0.5) at the final follow-up for fractures initially positioned inferiorly or intermediately (GT ratio < 0.5). GT positioning was measured radiographically and categorized according to the GT ratio described by Mutch et al. Secondary objectives were to compare secondary displacement rates between isolated GT fractures and GT fracture-dislocations, identify risk factors for secondary displacement, and compare active range of motion between patients with and without secondary displacement.

Results: A total of 115 patients (median age 57 years, 70% female) with a median follow-up of 104 days were included. Isolated GT fractures accounted for 81 cases (70%), whereas 34 (30%) were GT fracture-dislocations. Among 104 initially inferiorly or intermediately positioned GT fractures, 11 (11%) experienced secondary displacement. Secondary displacement rates were similar between isolated GT fractures (n = 7, 9.2%) and GT fracture-dislocations (n = 4, 14%; P = 0.482). A greater initial injury GT ratio was predictive for secondary displacement (P = 0.028). Patients with secondary displacement showed a negligible trend toward reduced active forward flexion (P = 0.156), although abduction and external rotation were not markedly different (P = 0.941 and P = 0.392, respectively).

Conclusion: Approximately 10% of nonsurgically managed GT fractures undergo secondary displacement. Secondary displacement rates were similar between isolated and GT fracture-dislocations. A more superior GT position at the initial injury was predictive of secondary displacement. No differences were found in active range of motion between patients with and without secondary displacement. These findings can help surgeons determine appropriate follow-up strategies for nonsurgically managed GT fractures.

Level of evidence: Diagnostic Level IV.