Surgical and Nonsurgical Treatment Produced Similar Outcomes for Proximal Humeral Fractures.

Abstract

Rangan A, Handoll H, Brealey S, Jefferson L, Keding A, Martin BC, Goodchild L, Chuang LH, Hewitt C, Torgerson D; PROFHER Trial Collaborators. Surgical vs nonsurgical treatment of adults with displaced fractures of the proximal humerus: the PROFHER randomized clinical trial. JAMA. 2015 Mar 10;313(10):1037-47. ### Question: In patients with displaced proximal humeral fractures involving the surgical neck, does surgical treatment result in better patient-reported outcomes than nonsurgical treatment? ### Design: Randomized (allocation concealed), blinded (data analysts), controlled trial with 2 years of follow-up. ### Setting: 32 acute care hospitals in the United Kingdom. ### Patients: 250 patients (mean age, 66 years; 77% women) who had sustained an acute displaced proximal humeral fracture involving the surgical neck in the past 3 weeks were enrolled. Exclusion criteria included shoulder joint dislocation, open fracture, clear indications for surgery, comorbid conditions precluding surgery or anesthesia, and patient refusal to be randomized to treatment. 215 patients (86%) completed the study. ### Intervention: Patients were allocated to surgery, which involved either internal fixation (plate and screws) that preserved the humeral head or humeral head replacement (hemiarthroplasty) according to surgeon preference (n = 125), or to nonsurgical treatment, which …