Surgical versus non-surgical management for minimally displaced isolated greater tuberosity in primary shoulder dislocation

Background: Management of minimally displaced greater tuberosity (GT) fractures following shoulder dislocation remains controversial. While surgical fixation is commonly employed in cases with significant displacement, the benefits of surgical versus non-surgical treatment in cases with minimal displacement remain unclear. Methods: In this retrospective non-randomized clinical study, 43 patients with minimally displaced GT fractures following anterior shoulder dislocation were evaluated. Patients were divided into surgical (n=12) and non-surgical (n=31) groups based on the treatment received. Functional outcomes were assessed after a minimum follow-up of two years using the American Shoulder and Elbow Surgeons (ASES) score and the Simple Shoulder Test (SST). Subgroup analysis was performed based on age, sex, work status, fracture type, and other clinical variables. Results: Overall functional outcomes were comparable between the two groups (ASES: 89.8±14.5 surgical vs. 89.1±15.2 non-surgical, P =0.88; SST: 11.1±1.1 vs. 10.4±1.6, P =0.17). However, complications occurred in 8.3% of surgical patients and 6.5% of non-surgical patients. Subgroup analysis showed significantly worse ASES and SST scores in patients with split fractures and comminution. In the young population subset, both treatment groups had similarly favorable outcomes. Conclusion: In cases of minimally displaced GT fractures following shoulder dislocation, non-surgical management provides comparable functional outcomes to surgical treatment. Surgical intervention may be reserved for specific fracture patterns, such as comminuted or split fractures, where poorer outcomes were observed. Careful patient selection is critical to optimizing results and minimizing complications.