Non-operative Treatment in Sweden of Proximal Humeral Fractures (NOSWEPH)

Proximal humeral fractures are common especially in the elderly population. The majority of these fractures are minimally displaced and may be treated non-operatively. There is however a controversy about which fractures that need surgery and randomised trials have not been able to show a clinically important advantage in patient reported outcome measures for those operated. The trend is therefore that also displaced and comminute fractures are treated non-operatively. There is however very little scientific support for how the non-operative treatment should be designed and performed. Therefore this prospective multicenter study is aiming at investigating the benefit of a four week immobilisation orthosis as compared to early range of motion exercises for those patients not assigned for surgery one week after the trauma.

The assessors are not involved in the treatment and the radiological assessment of images will be assessed with anonymyized images.

An orthosis with the broken arm in neutral position fixed for four weeks. After these four weeks the patient is instructed to start rehabilitation.

Patient reported outcome measure of pain at rest, at night and during activity in scales with 10 steps grading subjective assessment of pain

Inclusion Criteria: A proximal humeral fracture verified on radiology no older than 7-10 days. Exclusion Criteria: Surgically treated proximal humeral fracture Fracture only involving the greater tuberosity Previous surgery in the fractured shoulder Ongoing malignancy in the fractured shoulder Neurologic disease Radiating pain from the neck in the affected arm Associated vascular or nerve injuries Dementia Alcohol abuse Unwilling to participate in the trial

Handoll HH, Elliott J, Thillemann TM, Aluko P, Brorson S. Interventions for treating proximal humeral fractures in adults. Cochrane Database Syst Rev. 2022 Jun 21;6(6):CD000434. doi: 10.1002/14651858.CD000434.pub5.