Internal Fixation with a Locking Plate Was Not More Effective Than Nonoperative Treatment in Older Patients with Three-Part Proximal Humeral Fractures

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In older patients with a displaced three-part fracture of the proximal part of the humerus, does treatment with a locking plate improve quality of life and functional outcomes more than nonoperative treatment does?


Randomized (allocation concealed), unblinded, controlled trial with two years of follow-up.


Stockholm Söder Hospital in Stockholm, Sweden.


Sixty patients who were ≥55 years of age and had an acute, displaced three-part fracture of the surgical neck of the humerus caused by a simple fall. Patients had no previous shoulder problems, no severe cognitive impairment, and were not institutionalized. Patients with an absolute indication for surgery (completely displaced shaft in relation to the head fragment) were excluded. One patient withdrew immediately after randomization, leaving fifty-nine patients (mean age, 74 years; 81% women). Fifty-three patients (88%) were available for the twenty-four month follow-up.


Patients were allocated to open reduction and internal fixation with a locking plate (n = 30) or nonoperative treatment (n = 29). Surgery was done by one of two orthopaedic surgeons using the Philos plate (Synthes, Stockholm, Sweden). The plate was placed ≥8 mm distal to the upper end of …

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