Internal fixation with a locking plate was not more effective than nonoperative treatment in older patients with three-part proximal humeral fractures: Commentary

摘要

The study by Olerud and colleagues has important ramifications for orthopaedic surgeons who treat patients who have a proximal humeral fracture. Court-Brown and McQueen previously reported that, in patients who are older than seventy-five years, any displacement can be accepted provided that healing can be anticipated1. The study by Olerud and colleagues also concluded that a nonoperative approach in the treatment of displaced fragments about the humeral head can lead to results that are similar to those obtained in fractures treated operatively.There are several issues to consider. First, the study population appeared to consist of patients with both moderately and substantially displaced fractures. The second issue concerns the early comfort of the patient. Nonoperative treatment is often attempted but cannot be continued due to excessive pain. If patients can tolerate the first twenty-one days of treatment they will have an easier recovery afterwards. The locked plate allows for reconstruction of the fracture and stable fixation and maybe used for operative treatment for some patients. However, Olerud and colleagues demonstrated that, while operative reduction may be of benefit in the short term, it does not alter the long-term outcomes.