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Sling vs surgery for shoulder fracture

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An arm in a sling heals a shoulder fracture just as well as an operation, according to a study published in the journal PLOS Medicine.

The findings suggest that surgery using plates or metal screws should generally be avoided, because three weeks with the arm in a sling so that the shoulder is kept inactive yields the same results.

Researchers from Aarhus University, Viborg Regional Hospital, Denmark, and a number of university departments in Finland, Estonia and Sweden, set out to find the best form of treatment for fractures of the shoulder where the bones are displaced.

This often happens in connection with a fall on the shoulder and is a common type of fracture among older adults.

The study included 88 patients over the age of 60, all of whom had a displaced fracture of the shoulder. Half of the patients had surgery, while the other half only had the arm supported by a sling.

All 88 patients underwent rehabilitation under the supervision of a physiotherapist and were subsequently followed for two years.

The Disabilities of Arm, Shoulder and Hand (DASH) score, together with other measures of shoulder function and quality of life, and complications, showed that there there were no significant or clinically important differences between the two types of treatment.

Study leader Inger Mechlenburg, professor of orthopaedic rehabilitation from the Department of Clinical Medicine at Aarhus University and Aarhus University Hospital, described the findings as “thought-provoking”.

“Those who underwent surgery don’t have better shoulder function or less pain than those who didn’t. Our conclusion must therefore be that the least intrusive form of treatment shows itself to be the best,” she said.

“As there is no difference in the patients’ ability to carry out daily chores, their level of pain or quality of life with or without the displaced shoulder fracture surgery, then treatment with only a sling should be preferred, as the patients thereby avoid surgery-related pain and complications.”