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

Area of Science:

• Orthopedics
• Traumatology
• Geriatric Medicine

Background:

• Displaced 2-part proximal humerus fractures are common in older adults.
• The clinical effectiveness of surgical intervention versus non-operative management remains debated.
• Current surgical practices may not offer superior outcomes for these fractures.

Purpose of the Study:

• To compare the clinical effectiveness of surgical treatment with a locking plate versus non-operative treatment for displaced 2-part proximal humerus fractures.
• To evaluate patient-reported outcomes and complications at 2-year follow-up.
• To provide evidence-based guidance for the management of proximal humerus fractures in elderly patients.

Main Methods:

• A superiority, assessor-blinded, multicenter randomized trial involving 88 patients (≥60 years).
• Patients were randomized to either operative treatment (locking plate) or non-operative treatment.
• Primary outcome: Disabilities of Arm, Shoulder, and Hand (DASH) score at 2 years; secondary outcomes included pain, quality of life, and complications.

Main Results:

• No statistically or clinically significant differences in DASH scores between operative and non-operative groups at 2 years (18.5 vs 17.4, p=0.81).
• Similar outcomes observed for secondary measures including Constant-Murley score, pain, and quality of life.
• All three complications requiring secondary surgery occurred in the operative treatment group.

Conclusions:

• Surgical treatment with a locking plate does not offer significant clinical advantages over non-operative management for displaced 2-part proximal humerus fractures in patients aged 60 years and older.
• The findings suggest that routine surgical intervention for these fractures in the elderly population may not be beneficial.
• Further research may be warranted to refine treatment guidelines for proximal humerus fractures in older adults.