In these fractures either greater or lesser tuberosity may be involved. Displacement of the greater tuberosity (greater than 5 mm) that might produce impingement is important to correct.
Due to the instability and displacement of these fractures, operative treatment is commonly recommended. The fixation techniques of the tuberosities depends on the fracture pattern (single versus multifragmentary pattern), and the bone quality. Remember to include supplementary tension band sutures through the tendons inserting on avulsed tuberosities.
Fixation of comminuted metaphyseal fractures is more demanding. These fractures are associated with higher rates of complication (secondary displacement, malunion, implant failure). It is important to gain secure fixation in the short proximal humeral segment.
Nonoperative treatment should be reserved for patients with limited functional expectations.