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Operative vs non-operative treatment for 2-part proximal humerus fracture: A multicenter randomized controlled trial

PLoS Medicine Aug 07, 2019

Launonen AP, Sumrein BO, Reito A, et al. - Via a superiority, assessor-blinded, multicenter randomized trial in 6 hospitals in Finland, Estonia, Sweden, and Denmark of 88 individuals aged 60 years or older with displaced (more than 1 cm or 45 degrees) 2-part surgical or anatomical neck proximal humerus fracture, researchers assessed the clinical efficiency of surgery with locking plate in comparison with non-operative treatment for these fractures. At 2 years, the mean Disabilities of Arm, Shoulder, and Hand score (0 best, 100 worst) was 18.5 and 17.4 points for the operative treatment group and the non-operative group, respectively. No statistically or clinically important between-group variations in any of the outcome measures were noted at 2 years. All 3 complications leading to subsequent surgery were noted in the operative group. A limitation of the study was the lack of blinding in patient-reported outcome evaluation. The assessor physiotherapists were, nevertheless, blinded. In conclusion, in individuals, 60 years of age or older with displaced 2-part fractures of the proximal humerus, no important variation in clinical outcomes at 2 years among surgery and non-operative treatment could be discovered. Thus, in elderly individuals, the current practice of doing surgery on the majority of displaced proximal 2-part fractures of the humerus may not be advantageous.
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