Julkaistu 19.7.2019

Non-operative treatment of displaced proximal humerus fractures yields corresponding results to surgery and can save millions of euros per year

The results of a recent Nordic collaboration study showed that there is no difference in functional results between operative and non-operative treatment in persons aged 60 or more with displaced proximal humerus fractures. In the study, only fractures with a significant displacement between bone fragments were included. Traditionally, humerus fractures have been operatively treated using a metal plate and screws. In the non-operative treatment group, patients used a collar and cuff sling for three weeks and underwent instructed physiotherapy.

"The findings of the study are novel and challenge current treatment protocols. Moreover, the result had a positive impact on both the lives of the patients as well as on the economic cost of treatment”, says professor Ville Mattila, NITEP study group leader from Tampere University Hospital, Finland.

In Finland, abandoning those procedures that offer no benefit to the patient could result in savings of up to one million euros per year. Furthermore, patient recovery will be as successful as previously but without the surgery-related pain and complications.

Based on data from the Finnish National Hospital Discharge register, between 300 and 350 proximal humerus fracture operations are performed annually for persons aged 60 or more. On average, one hospital stay with operation costs 5700 euros. Using these new indications for surgery, approximately 100 to 150 operations could be reduced annually. As a result, the use of hospital resources can be reduced and savings made without affecting the quality of patient treatment and care.   

“We were surprised how rapidly patients recovered without surgery”, says Mattila. Patients used a collar and cuff sling for three weeks and patients did not have any pain after three months.

Proximal humerus fractures are more common in older persons than in younger adults. This fracture usually occurs as a result of falling, usually at home, directly on to the shoulder. In the proximal humerus, the bone is more fragile than lower in the forearm. The healing potential in the proximal humerus is, however, better than lower in the forearm. 

The trial included 88 patients who were followed for two years, and was conducted as a multinational, multicenter study in six trauma centers. The leading center was Tampere University Hospital, Finland. Other centers included Jyväskylä Central Hospital, Finland, Karolinska Hospital, Stockholm and Uppsala University Hospital in Sweden, Viborg Hospital in Denmark, and Tartu Hospital in Estonia.

The research group has been very motivated to conduct this trial. Since patients with proximal humerus fractures visit emergency departments, one of the researchers had to be on call all the time to evaluate whether patients could be included in the study. 

“I would like to express my gratitude to the whole research team, they have done a great job. But above all, my thanks go to the patients who were included in this trial. These novel trials that have challenged current beliefs were mainly carried out in Nordic countries where patients rely on public health care”, says Mattila.

In randomized trials, allotment is used when treatment is being selected. In Tampere, 90% of patients that suffered a fracture suitable for this trial wanted to participate. The next object for the NITEP study group is to assess whether older adults would benefit from surgery after distal radius fracture.

The results of this trial have been published in the Plos Medicine journal in July 2019.

Correspondence to:

Adjunct professor (tenure track) Ville Mattila
Tel +35840 582 1356, ville.mattila@tuni.fi

Link to journal