Treatment of isolated greater tuberosity fractures: a scoping review

BACKGROUND: There are no evidence-based guidelines to support the management of isolated greater tuberosity fractures. While the choice between nonoperative and operative treatment is generally based on the degree of fracture displacement, the definition of an acceptable displacement continues to be debated. Consequently, the ideal management of these fractures can be a therapeutic challenge. The objective of this study was to create an overview of the literature investigating the treatment of isolated greater tuberosity fractures.

METHODS: A scoping review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension guidelines for scoping reviews (PRISMA-ScR). Electronic databases MEDLINE, EMBASE, SPORTDiscus, and CINAHL were systematically searched from inception to September 29, 2024. Original studies investigating the treatment of isolated greater tuberosity fractures were eligible for inclusion. Screening of studies was independently performed by 3 reviewers. Data items were extracted using a standardized charting form. Risk of bias of the included studies was assessed by 2 independent reviewers using the Newcastle-Ottawa Quality Assessment Scale.

RESULTS: 3.788 records were identified in the search, 296 were retrieved for full-text screening, of which 59 were included. No randomized controlled trials were identified. 88% of the included studies were retrospective and 98% had a moderate or high risk of bias. Most of the included studies investigated operative treatment of displaced fractures (defined as >5 mm) in patient populations with a mean age between 40 and 60 years. Few studies investigated nonoperative treatment and treatment in young (<40 years) or elderly (>60 years) patients. Detailed fracture characteristics were not consistently reported. Accordingly, the size of the fragment was reported in 8% of the included studies, fractures were subclassified into avulsion, split or depression type in 29% of the included studies, and the direction of fragment displacement was reported in 34% of the included studies.

CONCLUSION: The literature regarding the treatment of isolated greater tuberosity fractures is comprised of studies with a moderate to high risk of bias and a lack of randomized controlled trials. A 5 mm fracture displacement threshold is often used to guide treatment, though it has not been validated in clinical studies. High-quality studies are needed to establish evidence-based guidelines and improve clinical decision-making.