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Operative versus no...
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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 ...
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2019-07-18
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Public Library of Science (PLoS),2019
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electronicrdacarrier
Nummerbeteckningar
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LIBRIS-ID:oai:DiVA.org:uu-393140
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https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-393140URI
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https://doi.org/10.1371/journal.pmed.1002855DOI
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http://kipublications.ki.se/Default.aspx?queryparsed=id:141583682URI
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Språk:engelska
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Sammanfattning på:engelska
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Ämneskategori:ref swepub-contenttype
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Ämneskategori:art swepub-publicationtype
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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 ...)
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Sumrein, Bakir O.Univ Tampere, Fac Med & Hlth Technol, Tampere, Finland;Tampere Univ Hosp, Tampere, Finland
(författare)
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Reito, AleksiCent Finland Cent Hosp, Dept Orthopaed, Jyvaskyla, Finland
(författare)
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Lepola, VesaUniv Tampere, Fac Med & Hlth Technol, Tampere, Finland;Tampere Univ Hosp, Tampere, Finland
(författare)
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Paloneva, JuhaCent Finland Cent Hosp, Dept Orthopaed, Jyvaskyla, Finland
(författare)
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Jonsson, Kenneth BUppsala universitet,Ortopedi(Swepub:uu)kennjons
(författare)
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Wolf, OlofUppsala universitet,Ortopedi(Swepub:uu)olowo902
(författare)
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Ström, PeterUppsala universitet,Ortopedi(Swepub:uu)petst243
(författare)
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Berg, Hans E.Karolinska Institutet
(författare)
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Fellander-Tsai, LiKarolinska Institutet
(författare)
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Jansson, Karl-AkeKarolinska Institutet
(författare)
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Fell, DanielKarolinska Inst, Div Orthoped & Biotechnol, Dept Clin Sci Intervent & Technol, Stockholm, Sweden;Karolinska Univ Hosp, Dept Orthoped, Huddinge, Sweden
(författare)
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Mechlenburg, IngerAarhus Univ Hosp, Dept Orthopaed Surg, Aarhus, Denmark;Aarhus Univ, Dept Clin Med, Aarhus, Denmark
(författare)
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Dossing, KajViborg Reg Hosp, Orthoped Dept, Viborg, Denmark
(författare)
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Ostergaard, HelleViborg Reg Hosp, Orthoped Dept, Viborg, Denmark
(författare)
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Martson, AareTartu Univ Hosp, Dept Traumatol & Orthoped, Tartu, Estonia;Tartu Univ, Tartu, Estonia
(författare)
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Laitinen, Minna K.Univ Tampere, Fac Med & Hlth Technol, Tampere, Finland;Tampere Univ Hosp, Tampere, Finland
(författare)
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Mattila, Ville M.Univ Tampere, Fac Med & Hlth Technol, Tampere, Finland;Tampere Univ Hosp, Tampere, Finland
(författare)
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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
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Ingår i:PLoS Medicine: Public Library of Science (PLoS)16:71549-12771549-1676
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Launonen, Antti ...
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Sumrein, Bakir O ...
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Reito, Aleksi
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Lepola, Vesa
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Paloneva, Juha
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Jonsson, Kenneth ...
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Wolf, Olof
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Ström, Peter
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Berg, Hans E.
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Fellander-Tsai, ...
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Jansson, Karl-Ak ...
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Fell, Daniel
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Mechlenburg, Ing ...
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Dossing, Kaj
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Ostergaard, Hell ...
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Martson, Aare
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Laitinen, Minna ...
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Mattila, Ville M ...
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