11 Mar Nonsurgical Treatments May Equal Surgery For Many Broken Shoulders
MedicalResearch.com Interview with:
Prof. Amar Rangan
Clinical Professor, Trauma & Orthopaedic Surgery
School of Medicine & Health, Durham University & Consultant Orthopaedic Surgeon
The James Cook University Hospital Middlesbrough
Medical Research: What is the background for this study? What are the main findings?
Prof. Rangan: The majority of fractures of the proximal humerus (broken shoulders) occur in people older than 65 years. Although surgical treatment is being increasingly used for the more serious (displaced) fractures, it has been unclear whether surgical intervention (fracture fixation or humeral head replacement) produces consistently better outcomes than non-surgical treatment (arm-sling); both followed by physiotherapy.
Our multicentre randomized controlled trial (ProFHER), funded by the UK National Institute for Health Research’s Health Technology Assessment Programme, recruited 250 patients aged 16 years or older (mean age, 66 years) who presented at the orthopedic departments of 32 acute UK National Health Service hospitals between September 2008 and April 2011 after sustaining the most common types of acute displaced fracture of the proximal humerus.
Data for 231 patients (92.4% of 250) included in the primary analysis showed that there was no significant difference between the two treatment groups over two years or at 6, 12 and 24 months follow-up in self-reported pain and function scores. Nor were there significant differences on measures of health-related quality of life, complications related to surgery or shoulder fracture, later surgery or treatment for these complications, and death.
Medical Research: What should clinicians and patients take away from your report?
Prof. Rangan: A broken shoulder can be a particularly painful injury and the function of the arm and shoulder can be considerably compromised – people don’t necessarily regain the independence they had before the injury. Although some of these fractures clearly need surgery, for the majority the results of ProFHER show that surgery does not result in a better outcome. Crucially, these results do not support the trend of increased surgery.
Medical Research: What recommendations do you have for future research as a result of this study?
Prof. Rangan: Greater attention needs to be given to identifying optimal non-surgical treatment strategies.
Non-surgical treatment including rehabilitation should remain the comparator for future research testing new interventions.
A prospective fully inclusive database of these fractures with collection of outcomes would help further clarify the effectiveness of interventions.
Citation:
MedicalResearch.com Interview with: Prof. Amar Rangan (2015). Nonsurgical Treatments May Equal Surgery For Many Broken Shoulders
[wysija_form id=”2″]
Last Updated on March 11, 2015 by Marie Benz MD FAAD