title: Hemiarthroplasty versus nonoperative treatment of displaced 4-part proximal humeral fractures in elderly patients: a randomized controlled trial.
abstract: BACKGROUND
  The aim of the study was to report the 2-year outcome after a displaced 4-part fracture of the proximal humerus in elderly patients randomized to treatment with a hemiarthroplasty (HA) or nonoperative treatment.
  
  
  METHODS
  We included 55 patients, mean age 77 (range, 58-92) years, 86% being women. Follow-up examinations were done at 4, 12, and 24 months. The main outcome measures were health-related quality of life (HRQoL) according to the EQ-5D and the DASH and Constant scores.
  
  
  RESULTS
  At the final 2-year follow-up the HRQoL was significantly better in the HA group compared to the nonoperative group, EQ-5D (index) score 0.81 compared to 0.65 (P = .02). The results for DASH and pain assessment were both in favor of the HA group, DASH score 30 versus 37 (P = .25) and pain according to VAS 15 versus 25 (P = .17). There were no significant differences regarding the Constant score or range of motion (ROM). Both groups achieved a mean flexion of approximately 90-95° and a mean abduction of 85-90°. The need for additional surgery was low: 3 patients in the HA group and 1 patient in the nonoperative group.
  
  
  CONCLUSIONS
  The results of the study demonstrated a significant advantage in quality of life in favor of HA, as compared to nonoperative treatment in elderly patients with a displaced 4-part fracture of the proximal humerus. The main advantage of HA appeared to be less pain while there were no differences in ROM.
authors.affiliation: Karolinska Institutet, Department of Clinical Science and Education, Section of Orthopaedics, Stockholm Söder Hospital, Sweden. per.olerud@sodersjukhuset.se
authors.forename: Per
authors.initials: P
authors.lastname: Olerud
authors.forename: Leif
authors.initials: L
authors.lastname: Ahrengart
authors.forename: Sari
authors.initials: S
authors.lastname: Ponzer
authors.forename: Jenny
authors.initials: J
authors.lastname: Saving
authors.forename: Jan
authors.initials: J
authors.lastname: Tidermark
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019643:Arthroplasty, Replacement / Q000379:methods*; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D007595:Joint Prosthesis; D008297:Male; D008875:Middle Aged; D009989:Orthotic Devices; D010147:Pain Measurement; D026741:Physical Therapy Modalities; D011788:Quality of Life; D016059:Range of Motion, Articular; D012784:Shoulder Fractures / Q000628:therapy*