Primary hemiarthroplasty versus conservative treatment for comminuted fractures of the proximal humerus in the elderly (ProCon): a multicenter randomized controlled trial
Den Hartog, Dennis × Van Lieshout, Esther M M Tuinebreijer, Wim E Polinder, Suzanne Van Beeck, Ed F Breederveld, Roelf S Bronkhorst, Maarten W G A Eerenberg, Jan Peter Rhemrev, Steven Roerdink, W Herbert Schraa, Gerrit Van der Vis, Harm M Van Thiel, Thom P H Patka, Peter Nijs, Stefaan Schep, Niels W L #
BMC Musculoskeletal Disorders vol:11
Fractures of the proximal humerus are associated with a profound temporary and sometimes permanent, impairment of function and quality of life. The treatment of comminuted fractures of the proximal humerus like selected three-or four-part fractures and split fractures of the humeral head is a demanding and unresolved problem, especially in the elderly. Locking plates appear to offer improved fixation; however, screw cut-out rates ranges due to fracture collapse are high. As this may lead to higher rates of revision surgery, it may be preferable to treat comminuted fractures in the elderly primarily with a prosthesis or non-operatively. Results from case series and a small-sample randomized controlled trial (RCT) suggest improved function and less pain after primary hemiarthroplasty (HA); however these studies had some limitations and a RCT is needed. The primary aim of this study is to compare the Constant scores (reflecting functional outcome and pain) at one year after primary HA versus non-operative treatment in elderly patients who sustained a comminuted proximal humeral fracture. Secondary aims include effects on functional outcome, pain, complications, quality of life, and cost-effectiveness.