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dc.contributor.authorLaunonen, AP
dc.contributor.authorSumrein, BO
dc.contributor.authorReito, A
dc.contributor.authorLepola, V
dc.contributor.authorPaloneva, J
dc.contributor.authorJonsson, KB
dc.contributor.authorWolf, O
dc.contributor.authorStröm, P
dc.contributor.authorBerg, HE
dc.contributor.authorFelländer-Tsai, L
dc.contributor.authorJansson, K
dc.contributor.authorFell, D
dc.contributor.authorMechlenburg, I
dc.contributor.authorDøssing, K
dc.contributor.authorØstergaard, H
dc.contributor.authorMärtson, A
dc.contributor.authorLaitinen, MK
dc.contributor.authorMattila, VM
dc.date.accessioned2020-06-24T08:23:05Z
dc.date.available2020-06-24T08:23:05Z
dc.date.issued2019
dc.identifier.urihttps://erepo.uef.fi/handle/123456789/8206
dc.description.abstractBackground Although increasingly used, the benefit of surgical treatment of displaced 2-part proximal humerus fractures has not been proven. This trial evaluates the clinical effectiveness of surgery with locking plate compared with non-operative treatment for these fractures. Methods and findings The NITEP group conducted a superiority, assessor-blinded, multicenter randomized trial in 6 hospitals in Finland, Estonia, Sweden, and Denmark. Eighty-eight patients aged 60 years or older with displaced (more than 1 cm or 45 degrees) 2-part surgical or anatomical neck proximal humerus fracture were randomly assigned in a 1:1 ratio to undergo either operative treatment with a locking plate or non-operative treatment. The mean age of patients was 72 years in the non-operative group and 73 years in the operative group, with a female sex distribution of 95% and 87%, respectively. Patients were recruited between February 2011 and April 2016. The primary outcome measure was Disabilities of Arm, Shoulder, and Hand (DASH) score at 2-year follow-up. Secondary outcomes included Constant–Murley score, the visual analogue scale for pain, the quality of life questionnaire 15D, EuroQol Group’s 5-dimension self-reported questionnaire EQ-5D, the Oxford Shoulder Score, and complications. The mean DASH score (0 best, 100 worst) at 2 years was 18.5 points for the operative treatment group and 17.4 points for the non-operative group (mean difference 1.1 [95% CI −7.8 to 9.4], p = 0.81). At 2 years, there were no statistically or clinically significant between-group differences in any of the outcome measures. All 3 complications resulting in secondary surgery occurred in the operative group. The lack of blinding in patient-reported outcome assessment is a limitation of the study. Our assessor physiotherapists were, however, blinded. Conclusions This trial found no significant difference in clinical outcomes at 2 years between surgery and non-operative treatment in patients 60 years of age or older with displaced 2-part fractures of the proximal humerus. These results suggest that the current practice of performing surgery on the majority of displaced proximal 2-part fractures of the humerus in older adults may not be beneficial.en
dc.language.isoenglantien
dc.publisherPublic Library of Scienceen
dc.relation.ispartofseriesPLoS medicineen
dc.relation.urihttps://doi.org/10.1371/journal.pmed.1002855en
dc.rightsCC BY http://creativecommons.org/licenses/by/4.0/en
dc.titleOperative versus non-operative treatment for 2-part proximal humerus fracture: A multicenter randomized controlled trialen
dc.description.versionpublished versionen
uef.solecris.id71493591en
dc.type.publicationarticleen
dc.rights.accessrights© 2019 Authorsen
dc.relation.doi10.1371/journal.pmed.1002855en
dc.description.reviewstatuspeerRevieweden
dc.relation.articlenumbere1002855en
dc.relation.issn1549-1277en
dc.relation.issue7en
dc.relation.volume16en
dc.rights.accesslevelopenAccessen
dc.type.okmA1en
dc.type.versioninfo:eu-repo/semantics/publishedVersionen


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