*3.2. Radiographic Results*

There were no cases of osteolysis or prosthetic loosening at final follow-up in all patients with radiographic follow-up (*n* = 23). There were two patients with calcification of the posterosuperior cuff and another with heterotopic ossification around both the scapular neck and humerus. Scapular notching (Grade 1) was documented in two patients (8.7%).

Greater tuberosity (GT) healing was present in 14 patients (61%) and the GT migrated superiorly and presented as a nonunion in five patients (22%). Four patients exhibited GT resorption at final follow-up (17%). Greater tuberosity healing was associated with greater ER (*p* = 0.03). Healing of the lesser tuberosity (LT) occurred in 18 patients (78%). There was no impact of LT healing on any clinical outcome measurement. However, higher rates of tuberosity healing were documented after a high-energy trauma.

#### *3.3. Comparison of Head-Split Types*

There were some differences in the absolute and modified CS, ASES score and internal rotation among the four fracture patterns (Table 3). Type 1 fractures seem to present the most favorable outcome, whereas fractures patterns with impairment of the LT (Type II–IV) seem to perform worse. In particular, LT head-split fragmentation seems to impact internal rotation the most.


**Table 3.** Clinical scores with regard to head-split fracture pattern types.

SD—standard deviation; CS—constant score; ASES—American shoulder and elbow surgeons assessment form; SST – Simple Shoulder Test; SSV—subjective shoulder score; ADLER—activities of daily living requiring active external rotation; GT—greater tuberosity; LT—lesser tuberosity. \* ANOVA for comparison of all four fracture types. \*\* Wilcoxon rank-sum test.

When comparing the "classic" fracture type I with the GT adjacent head-split fragment to that with a comminuted articular face, type IV exhibited worse function in all clinical outcome measurements, particularly for internal rotation (*p* < 0.001). Although the GT healing rate was higher for type IV fractures, this did not reach statistical significance.
