Conservative Slings Can Replace Surgery for Shoulder Fractures

A new study suggests that performing surgery on the majority of displaced proximal humerus fractures (PHFs) in older adults may not be beneficial.

Researchers at Tampere University Hospital (Finland), University Hospital (Stockholm, Sweden), Aarhus University Hospital (Denmark), and other institutions conducted a study involving 88 patients aged 60 years or older (the majority female) who were treated with a displaced 2-part anatomical neck PHF in six hospitals in Finland, Estonia, Sweden, and Denmark; all patients underwent rehabilitation under the supervision of a physiotherapist. The primary outcome measure was Disabilities of Arm, Shoulder, and Hand (DASH) score at two-year follow-up.

The study showed no differences between operative treatment and non-operative treatment, based on a patient-reported outcome measure (PROM) or quality of life (QOL) score. No statistically or clinically significant differences in PROMs were observed between the operative and non-operative treatment groups. The results were already valid one year after treatment. The study was published on July 18, 2019, in PLOS Medicine.

“The results are thought-provoking in that there is no difference between patients who underwent surgery and those who didn't. Those who underwent surgery don't have better shoulder function or less pain than those who didn't,” said lead author Professor Inger Mechlenburg, MD, of Aarhus University Hospital. “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.”

PHFs are among the most common fractures in the older adult population. The risk for having a PHF increases with age, especially after the age of 60 years, and most are associated with a low-energy fall. According to published literature, minimally displaced or 2-part fractures constitute between 77% and 84% of all fractures, for which non-operative treatment can be considered. Fracture comminution and displacement, especially in 3- and 4-part fractures, on the other hand, are considered to be potential indications for operative treatment.

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Tampere University Hospital
University Hospital
Aarhus University Hospital