Proximal humeral fractures account for approximately 5% of all fractures. The greater tuberosity of the humerus is an important anatomical structure involved in shoulder abduction and external rotation, and isolated greater tuberosity fractures account for 14%-21% of all proximal humeral fractures. Greater tuberosity fractures are also present in 5%-30% of anterior shoulder dislocations. Previous studies have recommended surgical treatment when displacement of a greater tuberosity fracture exceeds 5 mm. If inadequately treated, these injuries may result in poor functional outcomes. Compared with nonoperative treatment, surgical treatment aims to restore the anatomical position of the displaced greater tuberosity and preserve rotator cuff tendon integrity, thereby providing adequate mechanical stability, facilitating early postoperative rehabilitation, and reducing the risk of adhesion formation. However, no universally accepted gold-standard treatment has been established for displaced greater tuberosity fractures. Although most surgical techniques for displaced isolated greater tuberosity fractures have produced predictable outcomes, recurrent complete or partial displacement of fracture fragments remains frequently reported after surgery for comminuted greater tuberosity fractures involving three or more fragments. Such displacement may compromise postoperative rehabilitation, and the optimal treatment remains controversial.

To retrospectively compare the clinical outcomes of low-profile anatomic locking plate fixation combined with either suture fixation or suture anchor fixation for comminuted greater tuberosity fractures of the humerus.

A total of 54 patients with comminuted greater tuberosity fractures of the humerus who underwent low-profile anatomic locking plate fixation combined with either sutures or suture anchors at Jiangshan People's Hospital between January 2022 and August 2025 were included. The two groups were compared in terms of operative time, intraoperative blood loss, time to fracture union, Constant-Murley scores at 3 and 6 months postoperatively, postoperative pain, and complications.

Surgery was completed successfully in all patients. In the suture anchor group, the mean operative time was (54.13± 9.24) min, mean intraoperative blood loss was (56.68± 14.42) ml, and mean time to fracture union was (11.39± 2.25) weeks. The corresponding values in the suture group were (53.59± 10.12) min, (57.59± 12.27) ml, and (10.74± 3.12) weeks, respectively. No statistically significant differences were observed between the groups for these variables (all P > 0.05) . The Constant-Murley scores at 3 and 6 months postoperatively were significantly higher in the suture anchor group than in the suture group (both P < 0.05) . Visual analogue scale pain scores at both postoperative time points were significantly lower in the suture anchor group (both P < 0.05) . Regarding complications, partial loss of fracture reduction occurred in 2 patients in the suture anchor group. In the suture group, subacromial impingement occurred in 4 patients, and partial loss of fracture reduction occurred in 5 patients. The difference in the overall incidence of complications between the groups was statistically significant (P < 0.05) .

Low-profile anatomic locking plate fixation combined with suture anchors provides better short-term clinical outcomes than locking plate fixation combined with sutures for comminuted greater tuberosity fractures of the humerus. However, this conclusion is based on a relatively small sample and requires confirmation in larger studies.