PROFHER

Surgical vs nonsurgical treatment of adults with displaced fractures of the proximal humerus: the PROFHER randomized clinical trial.

Rangan A, Handoll H, Brealey S, et al. JAMA 2015 · PMID 25756440 · doi:10.1001/jama.2015.1629

Question

Does surgery improve outcomes over non-surgical treatment for displaced proximal humerus fractures involving the surgical neck?

Design

Pragmatic multicentre RCT in 32 UK NHS hospitals.

Patients

Adults with displaced fractures of the proximal humerus involving the surgical neck.

Intervention

Surgery (mostly locking plate fixation, some hemiarthroplasty)

Comparison

Sling immobilisation and physiotherapy

Primary outcome

Oxford Shoulder Score over 2 years

Key result

There was no significant difference in Oxford Shoulder Score between surgical and non-surgical treatment over two years.

Limitations

Exclusions such as fracture-dislocations and head-splitting fractures limit generalisability, and recruitment depended on surgeon uncertainty.

Impact on practice

Supports non-operative management for most displaced proximal humerus fractures in adults, particularly older patients.