{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T10:56:28Z","timestamp":1788692188930,"version":"build-2803163510"},"reference-count":88,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2025,7,21]],"date-time":"2025-07-21T00:00:00Z","timestamp":1753056000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Greater tuberosity fracture\u2013dislocations (GTFDs) represent a distinct subset of proximal humerus fractures, occurring in up to 57% of anterior glenohumeral dislocations. Malreduction may result in impingement, instability, and functional limitation. Treatment is influenced by the displacement magnitude and direction, bone quality, and patient activity level. Methods: This narrative review was based on a comprehensive search of PubMed, Scopus, and Web of Science for English-language articles published between January 2000 and March 2025. Studies on pathomechanics, classification, diagnosis, treatment, and outcomes of GTFDs in adult and pediatric populations were included. Data were analyzed to summarize the current evidence and identify clinical trends. Results: A displacement \u2265 5 mm is the standard surgical threshold, though superior or posterosuperior displacement \u2265 3 mm\u2014and \u22652 mm in overhead athletes\u2014may justify surgery. Conservative treatment remains appropriate for minimally displaced fractures but is associated with up to 48% subacromial impingement and 11% delayed surgery. Surgical options include arthroscopic repair for small or comminuted fragments and open reduction and internal fixation (ORIF) with screws or plates for larger, split-type fractures. Locking plates and double-row suture constructs demonstrate superior biomechanical performance compared with transosseous sutures. Reverse shoulder arthroplasty (RSA) is reserved for elderly patients with poor bone stock, cuff insufficiency, or severe comminution. Pediatric cases require physeal-sparing strategies. Conclusions: GTFDs management demands an individualized approach based on fragment displacement and direction, patient age and activity level, and bone quality. While 5 mm remains the common threshold, lower cutoffs are increasingly adopted in active patients. A tiered treatment algorithm integrating displacement thresholds, fracture morphology, and patient factors is proposed to support surgical decision making. The incorporation of fracture morphologic classifications further refines fixation strategy. Further prospective and pediatric-specific studies are needed to refine treatment algorithms and validate outcomes.<\/jats:p>","DOI":"10.3390\/jcm14145159","type":"journal-article","created":{"date-parts":[[2025,7,21]],"date-time":"2025-07-21T10:35:31Z","timestamp":1753094131000},"page":"5159","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Current Evidence and Surgical Strategies in the Management of Greater Tuberosity Fracture\u2013Dislocations: A Narrative Review"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6838-6910","authenticated-orcid":false,"given":"Gabriele","family":"Col\u00f2","sequence":"first","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Sant\u2019Anna Hospital, Via Ravona 20, 22042 Como, Italy"},{"name":"Multidisciplinary Research Center for Pathology and Surgery of the Musculoskeletal System, Department of Biotechnology and Life Sciences (DBSV), Insubria University, 21100 Varese, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4223-8485","authenticated-orcid":false,"given":"Federico","family":"Fusini","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic and Traumatology, Orthopaedic and Trauma Centre, University of Turin, Via Zuretti 29, 10124 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Faoro","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Sant\u2019Anna Hospital, Via Ravona 20, 22042 Como, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giacomo","family":"Popolizio","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Sant\u2019Anna Hospital, Via Ravona 20, 22042 Como, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2658-297X","authenticated-orcid":false,"given":"Sergio","family":"Ferraro","sequence":"additional","affiliation":[{"name":"Department of Surgery, Orthopedics and Traumatology, Asl1 SSR Liguria, 18039 Sanremo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giorgio","family":"Ippolito","sequence":"additional","affiliation":[{"name":"Trauma & Orthopaedic Department, Icot Hospital \u201cMarco Pasquali\u201d, 04100 Latina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7818-2209","authenticated-orcid":false,"given":"Massimiliano","family":"Leigheb","sequence":"additional","affiliation":[{"name":"Orthopaedics and Traumatology Unit, San Gaudenzio Clinic (Monza Polyclinic Group), Via Enrico Bottini 3, 28100 Novara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4645-8418","authenticated-orcid":false,"given":"Michele Francesco","family":"Surace","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Sant\u2019Anna Hospital, Via Ravona 20, 22042 Como, Italy"},{"name":"Multidisciplinary Research Center for Pathology and Surgery of the Musculoskeletal System, Department of Biotechnology and Life Sciences (DBSV), Insubria University, 21100 Varese, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1016\/j.jse.2005.07.004","article-title":"Mechanism of injury and morphology of the greater tuberosity fracture","volume":"15","author":"Bahrs","year":"2006","journal-title":"J. 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