Hemiarthroplasty versus Nonoperative Treatment of Comminuted Proximal Humeral Fractures: Results of the ProCon Multicenter Randomized Clinical Trial

Hartog, D den; Schep, N.W.L; Mahabier, KC; De, Zwart Ajm; Nijs, Stefaan; Verhofstad, Mhj; Ван, Л; ProCon, Investigators

doi:10.1055/s-0040-1717667

Cited by 1 publication

(2 citation statements)

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“…However, Olerud et al 21 reported significantly better health-related quality-of-life (HRQoL) measured with the EuroQol-5 Dimensions (EQ-5D) scores with HA than with nonoperative treatment (0.81 versus 0.65; p = 0.02) at the 2-year follow-up. Den Hartog et al 22 demonstrated a significantly better median Constant score (CS) in the nonoperative group at 2 years compared with the HA group (67 versus 48; p = 0.02), but not at all earlier time points. These studies demonstrated conflicting results in comparisons of HA and nonoperative treatment, even in comminuted injuries.…”

Section: Operative Versus Nonoperative Treatmentmentioning

confidence: 98%

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Current Controversies in the Treatment of Geriatric Proximal Humeral Fractures

Mease

Kraeutler

Gonzales-Luna

et al. 2021

Journal of Bone and Joint Surgery

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Multiple studies comparing nonoperative and operative treatment for displaced proximal humeral fractures in the geriatric population have demonstrated minimal differences in functional outcomes. Factors such as surgeon experience as well as the quality and maintenance of the reduction may influence operative outcomes, and their impact on these findings merits further investigation.In the treatment of 2 and 3-part fractures involving the surgical neck, intramedullary nailing has demonstrated functional outcomes that are comparable with those of open reduction and internal fixation (ORIF).In the geriatric population, reverse total shoulder arthroplasty has demonstrated improved functional outcomes, with a decreased rate of reoperation, compared with hemiarthroplasty. Tuberosity repair has been shown to improve functional outcomes and range of motion after both procedures and should be performed at the time of arthroplasty.Several authors have demonstrated the negative effect of osteopenia on outcomes after ORIF of proximal humeral fractures. Augmentative procedures, including cortical strut augmentation, are being investigated to address this issue; their role in the treatment of these fractures is unclear at this time.

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Section: Operative Versus Nonoperative Treatmentmentioning

confidence: 98%

“…Three RCTs comparing HA and nonoperative treatment in patients with comminuted PHFs were reviewed, and all had a mean patient age of ≥77 years 20-22 . The functional outcomes reported were heterogeneous (Table I).…”

Section: Operative Versus Nonoperative Treatmentmentioning

confidence: 99%