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

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.