What question did this study set out to answer?

To compare the functional outcomes and complications of nonoperative treatment versus surgical repair with a locking plate or hemiarthroplasty for displaced 3- and 4-part proximal humerus fractures in older patients.

November 28, 2023PLoS MedicineOpen Access

Surgery with locking plate or hemiarthroplasty versus nonoperative treatment of 3–4-part proximal humerus fractures in older patients (NITEP): An open-label randomized trial

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To compare the functional outcomes and complications of nonoperative treatment versus surgical repair with a locking plate or hemiarthroplasty for displaced 3- and 4-part proximal humerus fractures in older patients.
Multicenter, open-label, 3-arm randomized superiority trial (NCT01246167) allocating 160 patients aged 60 years and older (1:1:1) to nonoperative treatment (n=54), locking plate (n=52), or hemiarthroplasty (n=54).
Evaluated the primary outcome of Disabilities of the Arm, Shoulder, and Hand (DASH) score at 2-year follow-up with blinded outcome assessors, analyzing 123 patients in the intention-to-treat population (42 nonoperative, 44 locking plate, 37 hemiarthroplasty).
Mean 2-year DASH scores were 30.4 (SE 3.25) for nonoperative, 31.4 (SE 3.11) for locking plate, and 26.6 (SE 3.23) for hemiarthroplasty, showing no significant differences between nonoperative vs. locking plate (difference 1.07; 95% CI [-9.5, 11.7]; p = 0.97), nonoperative vs. hemiarthroplasty (difference 3.78; 95% CI [-7.0, 14.6]; p = 0.69), or locking plate vs. hemiarthroplasty (difference 4.84; 95% CI [-5.7, 15.4]; p = 0.53).
Complications at 2 years occurred in 5.8% (3/52) of nonoperative patients, 45% (22/49) of the locking plate group, and 10% (5/49) of the hemiarthroplasty group (p = 0.0004), alongside a 22% revision rate in the locking plate group.

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Implication

Randomized superiority trial finds no functional benefit from surgery for proximal humerus fractures in older adults, suggesting nonoperative care is preferable.

Cite This Study

Launonen et al. (2023) studied this question.

synapsesocial.com/papers/6a7dc238cf7e8b32dacb531f https://doi.org/10.1371/journal.pmed.1004308

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Implication

Randomized superiority trial finds no functional benefit from surgery for proximal humerus fractures in older adults, suggesting nonoperative care is preferable.

Surgery with locking plate or hemiarthroplasty versus nonoperative treatment of 3–4-part proximal humerus fractures in older patients (NITEP): An open-label randomized trial

Key Points

Discussion

Implication

Cite This Study

Surgery with locking plate or hemiarthroplasty versus nonoperative treatment of 3–4-part proximal humerus fractures in older patients (NITEP): An open-label randomized trial

Key Points

Discussion

Implication

Cite This Study

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