ProFHER

Full title

Proximal Fracture of the Humerus: Evaluation by Randomisation (ProFHER)

Background

Fractures of the proximal humerus (the top part of the upper arm bone) are very common, particularly in older adults who have weaker bones (osteoporotic).

The treatment for this type of fracture can vary, depending on several factors. Some fractures can be successfully treated by supporting the injured arm in a sling until the fracture mends (immobilisation). Whilst other fractures can be treated by surgery, usually in cases where the bone has broken in two or more pieces which are out of alignment (displaced).

Despite this little is known about whether surgical or non-surgical treatment is best for the more common types of displaced fracture.

What we did

The aim of this study was to investigate the effectiveness and cost-effectiveness of surgical and non-surgical treatments for 250 patients with displaced fractures of proximal humerus.

Using the Neer classification, we identified:

1. 18 patients with one-part fractures.

2. 128 patients with two-part fractures.

3. 104 patients with three or four-part fractures.

What we found

Mean age of the 250 patients was 66 years and 77% were female.

Oxford Shoulder Scores (OSS) were available for 215 patients at 2 years. There was no statistically or clinically significant differences in scores between the two treatment groups over the 2-year period or at individual time points.

There was no statistically significant difference between surgical and non-surgical group participants in:

1. SF-12 physical or mental component summary scores.

2. Surgical or shoulder fracture-related complications.

3. Those undergoing further shoulder-related therapy, either surgery or other therapy.

4. Mortality.

The cost of surgical intervention was, on average, £1780.73 more per patient than the cost of non-surgical intervention.