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Little Difference Between Surgical And Non-Surgical Treatment For Displaced Fracture Of Upper Arm

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Athletes who suffer a displaced fracture in the upper arm sometimes face a choice of whether or not to have surgery. The use of surgery for displaced proximal humeral fractures is increasing, but a new UK study suggests there is little difference in outcomes between the two patient groups.

The randomised clinical trial included 250 adults aged 24-92 years who had sustained a displaced fracture of the proximal humerus involving the surgical neck. Patients were randomly assigned to surgical treatment (fracture fixation or humeral head replacement) or non-surgical treatment (sling immobilisation).

Both groups had standardised outpatient and community-based rehabilitation and the patients were followed up for two years. Assessments were made according to the Oxford Shoulder Score (OSS), a shoulder-specific outcome measure that provides a total score based on the patient´s subjective assessment of pain and function.

Analysis of all the data showed that there were no statistically or clinically significant differences between surgical and non-surgical treatment either overall or at six, 12 or 24 months.

Additionally, there were no significant differences on measures such as health-related quality of life, complications related to surgery or shoulder fracture, complications requiring secondary surgery or treatment, or death.

Detailing their findings in JAMA, the Journal of the American Medical Association, the researchers said that the results do not support the trend of increased surgery for patients with displaced fractures of the proximal humerus.