ShoulderInternal fixation versus nonoperative treatment of displaced 3-part proximal humeral fractures in elderly patients: a randomized controlled trial
Section snippets
Patients
In an RCT with a 2-year follow-up, we included 60 patients with an acute displaced 3-part fracture of the surgical neck of the humerus, according to the classification of Neer,28, 29 allocated to treatment with open reduction and internal fixation with a locking plate or nonoperative treatment between April 2003 and March 2008. The fracture inclusion criteria, based on conventional radiographs and computer tomography, were a displacement of the shaft of more than 10 mm and/or >45° of angulation
Results
A flow chart for all patients included is shown in Figure 1. One patient in the nonoperative group opted to be excluded from the study after randomization and 1 patient in the locking plate group was treated with a primary hemiarthroplasty (HA). According to the radiological examinations, this patient had a 3-part fracture with a displaced greater tubercle and a minimally displaced lesser tubercle (2 mm), but at surgery a displacement of both tubercles exceeding 10 mm was diagnosed; ie, it was
Discussion
The results of the study indicate an advantage in functional outcome and quality of life in favor of the locking plate as compared to nonoperative treatment in elderly patients with a displaced 3-part fracture of the proximal humerus. However, despite a modern fixation technique and overall good primary reductions in the locking plate group, 13% of the patients had a severe complication requiring a major reoperation and 17% had a minor secondary surgical intervention. Regardless of the primary
Conclusion
In summary, the results of the study indicate an advantage in functional outcome and quality of life in favor of the locking plate, as compared to nonoperative treatment in elderly patients with a displaced 3-part fracture of the proximal humerus. The main advantage appeared to be an improved ROM. However, despite a modern fixation technique and overall good primary reductions in the locking plate group, 13% of the patients had a severe complication requiring a major reoperation and 17% had a
Disclaimer
The authors, their immediate families, and any research foundations with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.
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Cited by (0)
The study was supported in part by grants from the Trygg-Hansa Insurance Company and the Stockholm County Council.
The study was approved by the Local Ethics Committee in Huddinge, Stockholm, Sweden (number 342/02).
The study was conducted according to the principles of the Helsinki Declaration. All patients gave their informed consent to participate in the study and the protocol was approved by the Local Ethics Committee in Huddinge, Stockholm, Sweden (number 342/02).