Surgical Fixation and Non-Operative Management Outcomes in Proximal Humerus Fractures

Comparison of Surgical Fixation and Non-Operative Management Outcomes in Proximal Humerus Fractures

The management of proximal humerus fractures (PHFs) remains a significant challenge in orthopaedics. The acute treatment options for PHFs are numerous and are typically guided by the fracture pattern and functional demands of the patients. The most commonly used methods include non-operative management with a sling or surgical fixation. Although non-surgical treatment is a reasonable treatment option for the majority of humerus fractures, there is an increasing interest in surgical intervention. There are no evidence-based treatment recommendations, thus permitting large local variation in treatment preferences.

There are a number of studies in the literature about how outcome measures of the patients after PHFs management change, but these results generally compare functional results before and after treatment. Misra et al. stated that conservatively managed patients with PHFs have more pain and a poorer range of motion than those managed by either fixation or arthroplasty, while cochrane review stated that surgery is not superior to nonsurgical treatment in most proximal humerus fractures. Jayakumar et al. determined that kinesiophobia is one of the strongest predictors of functional limitation and recovery from a PHF is enhanced by overcoming fears of movement or reinjury within a week after injury.

There is no clear knowledge regarding how the surgical or conservative management used in the management of PHF affects the early results of assessment parameters. The aim of this study was to compare early results of surgical fixation versus non-operative management outcomes in patients with proximal humerus fractures.

Study Overview

• Status: Completed
• Conditions: Proximal Humeral Fracture

Detailed Description

Voluntary patients who have been diagnosed with proximal humerus fracture and managed by surgical or conservative will be included in the study.

Patients with stabilization after proximal humerus fracture with surgical fixation will be considered as the Surgery group, and patients treated with non-surgical treatment with sling immobilization will be considered as the Conservative group. Signed voluntary consent will be obtained from participants. Patients having surgical fixation or nonoperative management will be assessed for kinesiophobia, pain, range of motion, functional status, and quality of life.

• Study Type: Observational
• Enrollment (Actual): 40

Contacts and Locations

Study Locations

• Turkey
  • İstanbul
    • Küçükçekmece, İstanbul, Turkey
      • Ayşe Alpözgen

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 65 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

Patients with proximal humerus fracture who come to the orthopedic clinic.

Description

Inclusion Criteria:

• Stabilization after proximal humerus fracture with surgical fixation (post-op 3-6 weeks) or non-surgical treatment with sling immobilization (callus formation on radiography).
• Volunteer

Exclusion Criteria:

• Malunion tubercle majus,
• Advanced osteoporosis,
• Avascular necrosis of the humeral head,
• Presence of neurological and rheumatologic disease,
• Recurrent infection and open wound-incision in the region,
• Communication problems

Study Plan

How is the study designed?

Design Details

• Observational Models: Cohort
• Time Perspectives: Cross-Sectional

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort
Surgical Fixation Group; Open reduction with deltopectoral incision and humeral osteosynthesis with anatomic plates and screws will be performed for surgical fixation.
Non-Operative Group; Non-surgical treatment will be performed with sling immobilization.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Kinesiophobia	Tampa kinesiophobia scale will be used for determining of kinesiophobia or fear of movement.The Tampa Scale for Kinesiophobia is a 17 item questionnaire used to assess the subjective rating of kinesiophobia or fear of movement. The score varies between 17 and high scores indicate an increasing degree of kinesiophobia.	Baseline

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Shoulder Pain	A Visual Analogue Scale will be used for pain of rest, night and activity. It is a scale measuring the distance (mm) on the 10-cm line between the "no pain" (0) and and " worst pain (10).	Baseline
Range of Motion	Shoulder flexion, extension, external and internal rotation will be measured by using digital goniometer. It is a reliable and valid tool for measuring shoulder range of motion in individuals with healthy shoulders. Increasing the degree is considered as an improvement in the range of motion.	Baseline
Functional Status	The Disabilities of the Arm, Shoulder and Hand questionnaire will be used for measuring of self-rated upper-extremity disability and symptoms. The scale score ranging is from 0 (no disability) to 100 (most severe disability).	Baseline
Quality of Life of the patients	The quality of life will be assessed by using 36-Item Short Form Survey. The survey has eight sub scaled scores; vitality, physical functioning, bodily pain, general health perceptions, physical role functioning, emotional role functioning, social role functioning and mental health. Scores range from 0 - 100 and higher scores shows less disability.	Baseline

Collaborators and Investigators

• Sponsor: Istanbul University - Cerrahpasa (IUC)
• Investigators: Principal Investigator: Ayse Zengin Alpozgen, PhD, Istanbul University - Cerrahpasa (IUC)

Study record dates

Study Major Dates

• Study Start (Actual): March 12, 2021
• Primary Completion (Actual): May 12, 2023
• Study Completion (Actual): May 15, 2023

Study Registration Dates

• First Submitted: March 3, 2021
• First Submitted That Met QC Criteria: March 3, 2021
• First Posted (Actual): March 8, 2021

Study Record Updates

• Last Update Posted (Actual): July 19, 2023
• Last Update Submitted That Met QC Criteria: July 17, 2023
• Last Verified: July 1, 2023

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Wounds and Injuries; Shoulder Injuries; Arm Injuries; Fractures, Bone; Humeral Fractures; Shoulder Fractures
• Other Study ID Numbers: IUC1

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No