Locked plate fixation versus non-operative management for three and four-part proximal humeral fractures in elderly; A randomized controlled trial
In brief
Sling treatment scored better at 12 months in 52 older adults with complex shoulder fractures
In this randomized trial of 52 adults aged 65 or older with three- or four-part upper-arm fractures, sling treatment had better disability and shoulder-function scores at 12 months than plate surgery, though its disability score was worse at six months. Complication rates did not differ significantly; the small, single-hospital study leaves uncertainty about how broadly the results apply.
- Journal
- Injury (Q1)
- Published
- 21 September 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Maged Abouelsoud, Mahmoud Mohamed Abdel Wahab, Hesham Mohamed Kamal, Ali Ahmed Ali Mohamed
- PMID
- 42804936
- DOI
- 10.1016/j.injury.2026.113686
Why clinicians should know about it
- Picked for Orthopedics and Sports Medicine (paper of the day, 30 September 2026): Locked plate fixation yields better function than non‑operative
Abstract
BACKGROUND: In elderly patients, the proximal humerus fracture is the third most prevalent fracture, following fractures of the hip and distal radius, and is significantly associated with osteoporosis. This research aimed to determine the functional and radiological outcomes of internal fixation of 3- and 4-part proximal humeral fractures by locked plates compared with the outcomes obtained by non-operative management in the elderly. METHODS: In this prospective randomized trial, 52 elderly patients (≥65 years) with 3- or 4-part proximal humerus fractures were allocated to either nonoperative treatment with arm sling immobilization or operative fixation using a proximal humerus locking plate in Qena General Hospital from December 2020 to December 2023. Clinical and radiological assessments were conducted up to 12 months post-treatment, with functional outcomes measured by DASH and Constant scores. RESULTS: Six months after surgery, the Conservative group had a significantly higher DASH score than the Operative group. At 12 months, the Conservative group had a lower DASH score and a higher total Constant score (p < 0.05). There was no significant variance in the incidence of SAI, stiffness, deformity, or AVN among the conservative and operative groups (p > 0.05). The complication rate was 13.4%, with 5.7% of cases related to conservative treatment and 7.7% to operative treatment. CONCLUSION: Orthopaedic management of proximal humerus fractures requires proper evaluation, radiological views, patient age, and activity levels. Conservative treatment can provide good functional outcomes with a minimal complication rate, especially in elderly individuals.
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.