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Open Access Highly Accessed Study protocol

Conservative treatment, plate fixation, or prosthesis for proximal humeral fracture. A prospective randomized study

Antti P Launonen1*, Vesa Lepola1, Tapio Flinkkilä2, Niko Strandberg3, Johanna Ojanperä4, Pekka Rissanen5, Antti Malmivaara6, Ville M Mattila1, Petra Elo7, Timo Viljakka8 and Minna Laitinen1

Author Affiliations

1 Department of Orthopaedics, Tampere University Hospital, Teiskontie 35, PL2000, Tampere 33521, Finland

2 Oulu University Hospital, Kajaanintie 50, PL21, Oulu, 90029, Finland

3 Department of Orthopaedics and Traumatology, Turku University Hospital, Kiinamyllynkatu 4-8, PL 52, Turku, 20521, Finland

4 Department of Traumatology and Hand Surgery, Kuopio University Hospital, Puijonlaaksontie 2, PL1777, Kuopio, 70211, Finland

5 University of Tampere, Tampere School of Public Health, Tampere, 33014, Finland

6 National Institute for Health and Welfare, Mannerheimintie 166, PL 30, 00271, Helsinki, Finland

7 Tampere University Hospital; Imaging Center, Biokatu 8, PL2000, Tampere, 33521, Finland

8 Department of Hand Surgery, Tampere University Hospital, Teiskontie 35, PL2000, Tampere, 33521, Finland

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BMC Musculoskeletal Disorders 2012, 13:167  doi:10.1186/1471-2474-13-167

Published: 7 September 2012

Abstract

Background

Proximal humerus fracture is the third most common fracture type after hip and distal radius fracture in elderly patients. A comprehensive study by Palvanen et al. demonstrated an increase in the annual fracture rate of 13.7% per year over the past 33 years. Should this trend continue, the fracture rate would triple over the next three decades. The increasing incidence of low-energy fractures raises questions about the optimal treatment in terms of functional outcome, pain, and rehabilitation time, as well as the economical impact. Despite the high incidence and costs of proximal humerus fractures, there is currently no valid scientific evidence for the best treatment method. Several publications, including a Cochrane review outline the need for high-quality, well-designed randomized controlled trials.

Methods/Design

The study is a prospective, randomized, national multi-center trial. The hypothesis of the trial is that surgical treatment of displaced proximal humerus fractures achieves better functional outcome, pain relief, and patient satisfaction compared to conservative treatment. The trial is designed to compare conservative and surgical treatment of proximal humerus fractures in patients 60 years and older. The trial includes two strata. Stratum I compares surgical treatment with locking plates to conservative treatment for two-part fractures. Stratum II compares multi-fragmented fractures, including three- and four-part fractures. The aim of Stratum II is to compare conservative treatment, surgical treatment with the Philos locking plate, and hemiarthroplasty with an Epoca prosthesis. The primary outcome measure will be the Disabilities of the Arm, Shoulder and Hand (DASH) score and the secondary outcome measures will be the EuroQol-5D (EQ-5D) value, OSS, Constant-Murley Score, VAS, and 15D.

Recruiting time will be 3 years. The results will be analyzed after the 2-year follow-up period.

Discussion

This publication presents a prospective, randomized, national multi-center trial. It gives details of patient flow, randomization, aftercare and also ways of analysis of the material and ways to present and publish the results.

Trial registration

ClinicalTrials.gov identifier: NCT01246167

Keywords:
Proximal; Humerus; Fracture; Conservative; Operative; Locking plate; Prosthesis; Philos; Epoca; RCT