Does Immobilization Method Make a Difference in Conservative Management of Proximal Humeral Fractures? A Prospective Randomized Trial
In brief
No difference in function or healing across three shoulder immobilizers for proximal humeral fractures
In a randomized trial of 105 patients, Velpeau bandage, standard sling, and padded sling yielded similar scores on pain, function, and range of motion, and showed comparable rates of nonunion (4%) and malunion (21%). Because the devices performed alike, clinicians can choose the immobilizer based on comfort and cost, though larger studies are needed to confirm these findings.
- Journal
- Journal of shoulder and elbow surgery (Q1)
- Published
- 21 August 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Dr Murat Sarıkaş, Dr Mehmet Kapıcıoğlu, Dr Koray Şahin, Dr Kerem Bilsel
- PMID
- 42628626
- DOI
- 10.1016/j.jse.2026.08.004
Why clinicians should know about it
- Picked for Orthopedics and Sports Medicine (top studies of the week, 23 August 2026): Randomized trial of immobilization methods for proximal humerus fractures
Abstract
BACKGROUND/OBJECTIVE: The role of conservative treatment in proximal humerus fractures (PHFs) has been increasing with emerging evidence. However, the optimal conservative treatment protocol remains unclear. In particular, the immobilization method-an essential component of conservative management-has not been adequately investigated in the literature. This study aimed to compare the clinical and radiological outcomes of three different immobilization devices that position the shoulder in varying degrees of immobilization. METHODS: This prospective randomized clinical trial included patients diagnosed with PHFs and treated conservatively. Clinical outcome measures included the Subjective Shoulder Value (SSV), Visual Analog Scale (VAS), American Shoulder and Elbow Surgeons (ASES) score, Disabilities of the Arm, Shoulder and Hand (DASH) score, Constant score, and range of motion. The three study groups were compared in terms of clinical and radiological outcomes. RESULTS: Data from 34 patients in Group A (Velpeau bandage), 39 patients in Group B (standard shoulder-arm sling), and 32 patients in Group C (padded shoulder-arm sling) were analyzed. The overall mean age was 60.6 ± 15.9 years, and 67 patients (63.8%) were female. The groups were comparable in baseline characteristics, including age and fracture severity according to Neer classification. No significant differences were observed among the groups in terms of SSV, VAS, ASES, DASH, Constant scores, or range of motion. Radiologically, nonunion occurred in 5 of 120 patients (4.1%), while malunion was detected in 22 of 105 patients (21%). Malunion rates were comparable across the study groups. CONCLUSIONS: The type of immobilization device used in the conservative treatment of PHFs does not appear to influence functional or radiological outcomes. Therefore, the choice of immobilization method may be guided by patient comfort and cost considerations. LEVEL OF EVIDENCE: Level I; Prospective Randomized Controlled Trial.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.