General considerations

B1.1 and B1.3 fractures are impacted surgical neck fractures with displaced greater tuberosity fractures. Tuberosity malunion or nonunion, and secondary fracture displacement can be problematic for these injuries. However, the humeral head blood supply is seldom totally disrupted, thus avascular necrosis is unusual.

Surgical treatment for the greater tuberosity fragment must correct any displacement greater than 5 mm and provide stable fixation for early motion. Tuberosity fixation can be supplemented with a tension band suture through its rotator cuff insertion for increased stability. If surgery is done, fixation of the metaphyseal (surgical neck) component is typically included.

If the greater tuberosity is not significantly displaced, conservative treatment may be considered, and can give good results if the greater tuberosity does not impinge on the coraco-acromial arch.