Surgical vs. non-surgical treatment of humeral fractures similar in outcome

1. There were no overall statistically significant differences between patients with humeral fractures treated with surgical treatment and those treated with nonsurgical treatment after adjustment for smoking status or clustering by center.

2. Surgical patients (24%) experienced a complication slightly more often than nonsurgical patients (18%) but the difference did not reach statistical significance.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Proximal humeral fractures are common in the elderly, with elderly women at particularly high risk due to decreased bone mineral density. While both surgical and nonsurgical treatment options are available, proximal humeral fractures are increasingly being treated using surgical interventions. Due to the increasing use of surgery and the tendency of this trend to increase treatment costs, this study, the Proximal Fracture of the Humerus Evaluation by Randomization (PROFHER) trial, was performed to determine whether surgical or nonsurgical treatments resulted in better outcomes. Among 250 patients in the UK with displaced proximal humeral fractures involving the surgical neck, there was no significant difference in outcome at 2 years follow-up.

Strengths of this study include the randomized, multicenter clinical design. Study results were limited by the self-reported nature of the primary outcome, the small study population, and the limited racial diversity of the patient population. Nevertheless, these results argue against current surgical treatment trends for proximal humeral fractures and highlight the equivalent value of non-surgical intervention.

Click to read the study, published today in JAMA

Relevant Reading: Interventions for treating proximal humeral fractures in adults

In-Depth [randomized controlled trial]: This study evaluated 250 patients from orthopedic departments at 32 UK National Health Service hospitals between September 2008 and April 2011. The mean age was 66 years (range, 24-92 years). 77% of subjects were female and 99.6% were white. The primary outcome was based on questionnaires capturing patient-reported pain and function using the previously validated Oxford Shoulder Score (OSS). Based on questionnaire responses at 3,6,12, and 24 months post intervention, there were no overall statistically significant differences between treatment with surgical or nonsurgical treatment after adjustment for smoking status (P = .59) or clustering by center (P = .46). 24% of surgical patients experienced a complications compared to 18% in the nonsurgical group (P=.28), with the most common complication in the surgical group relating to problems with the metalwork used in internal fixation. 9% of participants in either group required secondary surgery to the shoulder.

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