title: Surgical treatment with an angular stable plate for complex displaced proximal humeral fractures in elderly patients: a randomized controlled trial.
abstract: OBJECTIVE
  The objective of the study was to evaluate functional outcome, patient self-assessment, and radiographic outcome at 1 year in displaced three- and four-part proximal humeral fractures (OTA group 11-B2 and 11-C2).
  
  
  METHODS
  Randomized controlled trial.
  
  
  METHODS
  Academic medical center.
  
  
  METHODS
  Fifty patients aged 60 years or older with displaced three- or four-part proximal humeral fractures and no previous shoulder injuries were randomized either to surgical treatment or to conservative closed treatment. Twenty-five patients were included in each group. Forty-eight patients completed 12-month follow-up. Two surgical patients died within 3 months.
  
  
  METHODS
  The surgically treated group had a standardized surgical treatment with open reduction and internal fixation using an angular stable plate and cerclages. Instructed physical therapy started the third postoperative day. The conservative treatment group had a standardized nonoperative treatment that included closed reduction if displacement between the head and metaphyseal shaft fragment exceeded 50% of the diaphyseal diameter. Physical therapy started on the fifteenth postoperative day.
  
  
  METHODS
  The main outcome was the mean difference in Constant score between the injured and noninjured shoulder at 12 months. The secondary outcomes were patient self-assessment (American Shoulder and Elbow Surgeons score) and radiographic ratings at 12 months.
  
  
  RESULTS
  At 12 months, mean Constant scores favored conservative treatment by 2.4 points (nonsignificant; P = 0.62). There was no significant difference in mean patient self-assessment. However, radiographic outcomes were significantly better for surgically treated patients.
  
  
  CONCLUSIONS
  There is no evidence of a difference in functional outcome at 1-year follow-up between surgical treatment and conservative treatment of displaced proximal humeral fractures in elderly patients.
authors.affiliation: Orthopedic Department, Oslo University Hospital Ullevål HF, Oslo, Norway. torfja@online.no
authors.forename: Tore
authors.initials: T
authors.lastname: Fjalestad
authors.forename: Margrethe Ø
authors.initials: MØ
authors.lastname: Hole
authors.forename: Inger Anette Hynås
authors.initials: IA
authors.lastname: Hovden
authors.forename: Judith
authors.initials: J
authors.lastname: Blücher
authors.forename: Knut
authors.initials: K
authors.lastname: Strømsøe
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001860:Bone Plates; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation* / Q000379:methods*; D017102:Fracture Healing; D017759:Fractures, Malunited / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D012784:Shoulder Fractures / Q000175:diagnosis / Q000601:surgery*; D016896:Treatment Outcome