Constant score for functional outcome in operative and non-operative management in isolated greater tuberosity fractures of humerus bone.

Fractures of the greater tuberosity (GT) often occur with more complex proximal humerus fractures and are less frequently observed as an isolated pathology. Only 14-20% of proximal humerus fractures are isolated lesions of the GT. Up to 30% of these fractures are associated with anterior glenohumeral dislocations. According to Neer, a displacement of the fragment >5mm and 30°, or >3 mm of displacement in active patients involved in frequent overhead activity is believed to be an indication for operative treatment. However, indication for all other fractures had managed by nonoperative treatment is unclear. Currently, there is a lack of evidence in the literature to support either conservative or operative treatment strategies in GT humerus fractures. The fracture type and the etiology of the fracture impact the decision- making and the final outcome also remains unclear. age of more than 65 years as an important risk factor for secondary displacement in the conservative management of fractures of the greater tuberosity. Furthermore, fracture type and shoulder joint dislocations were factors associated with show increased relative risks for secondary fragment displacement.

Inclusion Criteria:

• 1-history of traumatic isolated GT fracture.

Exclusion Criteria:

- 1- associated proximal humeral fracture.

2 - previous shoulder pathology.

For conservative cases

• 1ist 4 weeks abduction sling.
• 2end 2 weeks active assisted movement + abduction sling.
• After 6 weeks active movement. For operative cases
• Day one passive movement.
• After 4 weeks active assisted movement.
• After 6 weeks active movement

Follow up conservative and operative cases for one year, radiological assessment by x-ray and clinical assessment follow up at 1.5,3,6,9 month and at 1 year using Constant score

1. isolated GT fracture
2. age 20-60