What are the Patient Reported Outcomes, Functional Limitations and Complications after Lesser Tuberosity Fractures? A Systematic Review of 172 Patients

Abstract Background Lesser tuberosity fractures are relatively rare, with an incidence of 0.46 per 100,000 persons per year. This systematic review was performed to address patient reported outcomes (PROMs), shoulder function and complications after lesser tuberosity fractures in pediatric and adult patients, as well as patients with an associated posterior shoulder dislocation. Within these groups, identical outcomes were evaluated for non-operative, surgical, acute and delayed treatment. Method A comprehensive search was carried out in multiple databases. Articles were included if patients sustained a lesser tuberosity fracture without a concomitant proximal humerus fracture. There were no restrictions on age, type of treatment, fragment displacement, time to presentation or associated injuries. Results 1644 records were screened for eligibility of which 71 studies were included (n=172). Surgical treatment was provided to 50 of 62 (81%) pediatric patients, 49 of 66 (74%) adults, and 34 of 44 (77%) patients with an associated posterior shoulder dislocation. In the pediatric group, the mean of PROMs was 94 (range 70-100) and among adults 89 (range 85-100). In the posterior shoulder dislocation group 89% did not regain full range of motion and the complication rate was 17%. In pediatric patients, surgery was associated with fewer complications (p=0.021) compared to non-operative treatment. Conclusion Pediatric patients have excellent outcomes after lesser tuberosity fractures and respond well to surgical treatment. Adults have acceptable outcomes but patients with a posterior shoulder dislocation have impaired range of shoulder movement and are more likely to develop complications compared to adults.