Let Us Agree to Disagree on Operative Versus Nonoperative Treatment for Proximal Humerus Fractures: A Multicenter International Prospective Cohort Study of Gray-Zone, Clinical Equipoise Fractures
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View abstract on PubMed
Summary
This summary is machine-generated.Operative versus nonoperative treatment for displaced proximal humerus fractures shows no significant difference in long-term arm function. However, surgery may offer short-term pain relief and improved shoulder value, especially for active patients.
Area Of Science
- Orthopedic Surgery
- Traumatology
- Upper Extremity Fractures
Background
- The optimal treatment strategy for proximal humerus fractures is a subject of ongoing international debate.
- Displaced fractures present a particular challenge in determining the most effective management approach.
Purpose Of The Study
- To compare the efficacy of operative versus nonoperative treatment for displaced proximal humerus fractures.
- To evaluate functional outcomes and patient-reported measures following surgical and non-surgical interventions.
Main Methods
- An international multicenter prospective study involving 226 patients with acute proximal humerus fractures.
- Patients were included based on clinical equipoise, where no consensus on optimal treatment existed.
- Primary outcome was Quick Disability of the Arm, Shoulder, and Hand (QuickDASH) at 1 year; secondary outcomes included pain, EQ5D, and Subjective Shoulder Value (SSV).
Main Results
- No significant difference in QuickDASH scores between operative and nonoperative groups at 1 year (p = 0.73).
- Operative treatment led to lower Numeric Rating Scale (NRS) pain scores and higher EQ5D and Subjective Shoulder Value (SSV) at 6 weeks.
- At 1 year, operative treatment showed a higher SSV (p = 0.002), while EQ5D remained comparable.
Conclusions
- No difference in long-term functional outcomes (QuickDASH) between operative and nonoperative treatments for displaced proximal humerus fractures.
- Operative intervention may benefit younger, active patients by reducing short-term pain and facilitating earlier return to sport or work.
- Patient-tailored care should consider these short-term benefits when counseling treatment options.
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