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  • Launonen, Antti P.Univ Tampere, Fac Med & Hlth Technol, Tampere, Finland;Tampere Univ Hosp, Tampere, Finland (författare)

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

  • Artikel/kapitelEngelska2019

Förlag, utgivningsår, omfång ...

  • 2019-07-18
  • Public Library of Science (PLoS),2019
  • electronicrdacarrier

Nummerbeteckningar

  • LIBRIS-ID:oai:DiVA.org:uu-393140
  • https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-393140URI
  • https://doi.org/10.1371/journal.pmed.1002855DOI
  • http://kipublications.ki.se/Default.aspx?queryparsed=id:141583682URI

Kompletterande språkuppgifter

  • Språk:engelska
  • Sammanfattning på:engelska

Ingår i deldatabas

Klassifikation

  • Ämneskategori:ref swepub-contenttype
  • Ämneskategori:art swepub-publicationtype

Anmärkningar

  • BackgroundAlthough increasingly used, the benefit of surgical treatment of displaced 2-part proximal humerus fractures has not been proven. This trial evaluates the clinical effectiveness of surgery with locking plate compared with non-operative treatment for these fractures.Methods and findingsThe NITEP group conducted a superiority, assessor-blinded, multicenter randomized trial in 6 hospitals in Finland, Estonia, Sweden, and Denmark. Eighty-eight patients aged 60 years or older with displaced (more than 1 cm or 45 degrees) 2-part surgical or anatomical neck proximal humerus fracture were randomly assigned in a 1:1 ratio to undergo either operative treatment with a locking plate or non-operative treatment. The mean age of patients was 72 years in the non-operative group and 73 years in the operative group, with a female sex distribution of 95% and 87%, respectively. Patients were recruited between February 2011 and April 2016. The primary outcome measure was Disabilities of Arm, Shoulder, and Hand (DASH) score at 2-year follow-up. Secondary outcomes included Constant–Murley score, the visual analogue scale for pain, the quality of life questionnaire 15D, EuroQol Group’s 5-dimension self-reported questionnaire EQ-5D, the Oxford Shoulder Score, and complications. The mean DASH score (0 best, 100 worst) at 2 years was 18.5 points for the operative treatment group and 17.4 points for the non-operative group (mean difference 1.1 [95% CI −7.8 to 9.4], p = 0.81). At 2 years, there were no statistically or clinically significant between-group differences in any of the outcome measures. All 3 complications resulting in secondary surgery occurred in the operative group. The lack of blinding in patient-reported outcome assessment is a limitation of the study. Our assessor physiotherapists were, however, blinded.ConclusionsThis trial found no significant difference in clinical outcomes at 2 years between surgery and non-operative treatment in patients 60 years of age or older with displaced 2-part fractures of the proximal humerus. These results suggest that the current practice of performing surgery on the majority of displaced proximal 2-part fractures of the humerus in older adults may not be beneficial.

Ämnesord och genrebeteckningar

Biuppslag (personer, institutioner, konferenser, titlar ...)

  • Sumrein, Bakir O.Univ Tampere, Fac Med & Hlth Technol, Tampere, Finland;Tampere Univ Hosp, Tampere, Finland (författare)
  • Reito, AleksiCent Finland Cent Hosp, Dept Orthopaed, Jyvaskyla, Finland (författare)
  • Lepola, VesaUniv Tampere, Fac Med & Hlth Technol, Tampere, Finland;Tampere Univ Hosp, Tampere, Finland (författare)
  • Paloneva, JuhaCent Finland Cent Hosp, Dept Orthopaed, Jyvaskyla, Finland (författare)
  • Jonsson, Kenneth BUppsala universitet,Ortopedi(Swepub:uu)kennjons (författare)
  • Wolf, OlofUppsala universitet,Ortopedi(Swepub:uu)olowo902 (författare)
  • Ström, PeterUppsala universitet,Ortopedi(Swepub:uu)petst243 (författare)
  • Berg, Hans E.Karolinska Institutet (författare)
  • Fellander-Tsai, LiKarolinska Institutet (författare)
  • Jansson, Karl-AkeKarolinska Institutet (författare)
  • Fell, DanielKarolinska Inst, Div Orthoped & Biotechnol, Dept Clin Sci Intervent & Technol, Stockholm, Sweden;Karolinska Univ Hosp, Dept Orthoped, Huddinge, Sweden (författare)
  • Mechlenburg, IngerAarhus Univ Hosp, Dept Orthopaed Surg, Aarhus, Denmark;Aarhus Univ, Dept Clin Med, Aarhus, Denmark (författare)
  • Dossing, KajViborg Reg Hosp, Orthoped Dept, Viborg, Denmark (författare)
  • Ostergaard, HelleViborg Reg Hosp, Orthoped Dept, Viborg, Denmark (författare)
  • Martson, AareTartu Univ Hosp, Dept Traumatol & Orthoped, Tartu, Estonia;Tartu Univ, Tartu, Estonia (författare)
  • Laitinen, Minna K.Univ Tampere, Fac Med & Hlth Technol, Tampere, Finland;Tampere Univ Hosp, Tampere, Finland (författare)
  • Mattila, Ville M.Univ Tampere, Fac Med & Hlth Technol, Tampere, Finland;Tampere Univ Hosp, Tampere, Finland (författare)
  • Univ Tampere, Fac Med & Hlth Technol, Tampere, Finland;Tampere Univ Hosp, Tampere, FinlandCent Finland Cent Hosp, Dept Orthopaed, Jyvaskyla, Finland (creator_code:org_t)

Sammanhörande titlar

  • Ingår i:PLoS Medicine: Public Library of Science (PLoS)16:71549-12771549-1676

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