title: Minimally displaced fractures of the greater tuberosity: outcome of non-operative treatment.
abstract: BACKGROUND
  Minimally displaced (<3 mm) and non-displaced fractures of the proximal humerus are a common source of disability; nevertheless, there is no agreement on the recommended rehabilitation program in these patients. The purpose of this study was to evaluate the outcome of this group of patients and describe the rehabilitation protocol we have used for the treatment of this injury.
  
  
  METHODS
  We retrospectively analyzed the records of patients diagnosed with minimally displaced (<3 mm) fractures of the greater tuberosity who were admitted to our institute between June 2007 and May 2008. Patients were treated with a three-phase protocol. In the first phase, patients were immobilized in a sling for 3 weeks. In the second phase, pendular and active assisted exercises were begun 3 to 6 weeks after the injury. In the third phase, active exercises were commenced starting 6 weeks after injury.
  
  
  RESULTS
  Sixty-nine patients matched our inclusion and exclusion criteria. At an average follow-up of 31 months (range, 26-41 months), the average Constant score improved from 40 points (range, 33-58 points) to 95 points (range, 75-100 points). Average satisfaction score improved from 4.2 of 10 (range, 2-6) to 9.5 of 10 (range, 7-10). The reported average duration of pain and decreased range of motion from the time of injury was 8.1 months (range, 1-24 months).
  
  
  CONCLUSIONS
  When the diagnosis of a minimally displaced fracture of the proximal humerus is made, the patient can be reassured that a favorable outcome is anticipated with a staged rehabilitation protocol. Nevertheless, clinicians and patients should be aware that full recovery from the injury may take an average of 8 months.
authors: Orthopaedic Division, Tel Aviv Souraski Medical Center, Tel Aviv, Israel. Electronic address: udirath@hotmail.com.
authors: Ehud
authors: E
authors: Rath
authors: Nassim
authors: N
authors: Alkrinawi
authors: Ofer
authors: O
authors: Levy
authors: Ronen
authors: R
authors: Debbi
authors: Eyal
authors: E
authors: Amar
authors: Ehud
authors: E
authors: Atoun
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D005592:Fracture Fixation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D026741:Physical Therapy Modalities; D016059:Range of Motion, Articular / Q000502:physiology*; D020127:Recovery of Function; D012189:Retrospective Studies; D012784:Shoulder Fractures / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D000070599:Shoulder Injuries; D012785:Shoulder Joint / Q000503:physiopathology*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Case Series; Level IV; Minimally displaced; Treatment Study; fracture; greater tuberosity; non-displaced; rehabilitation