Background The proximal humerus fracture is a common injury, but the optimal management is much debated. The decision for operative or nonoperative treatment is strongly influenced by patient specific factors, regional and cultural differences and the preference of the patient and treating surgeon. The aim of this study is to compare operative and nonoperative treatment of proximal humerus fractures for those patients for whom there is disagreement about optimal management. Methods and analysis This protocol describes an international multicenter prospective cohort study, in which all patients of 18 years and older presenting within three weeks after injury with a radiographically diagnosed displaced proximal humerus fracture can be included. Based on patient characteristics and radiographic images several clinical experts advise on the preferred treatment option. In case of disagreement among the experts, the patient can be included in the study. The actual treatment that will be delivered is at the discretion of the treating physician. The primary outcome is the QuickDash score at 12 months. Propensity score matching will be used to control for potential confounding of the relation between treatment modality and QuickDash scores. Discussion The LADON study is an international multicenter prospective cohort study with a relatively new methodological study design. This study is a “natural experiment” meaning patients receive standard local treatment and surgeons perform standard local procedures, therefore high participation rates of patients and surgeons are expected. Patients are only included after expert panel evaluation, when there is proven disagreement between experts, which makes this a unique study design. Through this inclusion process, we create two comparable groups whom received different treatments and where expert disagree about the already initiated treatment. Since we are zooming in on this particular patient group, confounding will be largely mitigated. Internationally the treatment of proximal humerus fractures are still much debated and differs much per country and hospital. This observational study with a natural experiment design will create insight into which treatment modality is to be preferred for patients in whom there is disagreement about the optimal treatment strategy. Trial registration Registered in Netherlands trial register NL9357 and Swiss trial register CH 2020–00961; https://clinicaltrials.gov/.
Objective To date it remains unclear whether superior or anterior plating is the best option for treating midshaft clavicular fractures. The aim of this study was to compare both techniques with regard to the need of implant removal due to hardware irritation or uncomforting during daily activities, to healing and to complications. Methods This was a retrospective study on all midshaft clavicular fractures treated operatively between 2017 and 2019 in two hospitals different in respect to anterior versus superior plating for midshaft clavicular fractures in Switzerland. The primary outcome was the number of implant removal due to hardware irritation, uncomforting, weather sensitivity or the patients wish for removal, whereas the specific reason was not evaluated. Secondary outcomes were time to union, complications, re-interventions and range-of-motion during the follow-up period of at least 6-months. Results In total 171 patients were included in the study of which 89 (52%) received anterior plating and 82 (48%) superior plating. The overall mean age was 45 years (SD 16). There was no significant difference between anterior and superior plating in the number of implant removals (39.3% versus 45.1%), infection rate (1.1% versus 1.2%), implant failure (1.1% versus 0%), non-union (1.1% and 0%) and time to union (mean 40 weeks versus 51 weeks). Ninty-four patients had a documented range of motion after a follow up from 6 up to 12 months with no significant difference in anteflexion (mean 170 degree anterior versus 178 degree superior) and abduction (mean 166 degree versus 176 degree). Conclusion There is no significant difference between anterior and superior plating for midshaft clavicular fractures with regard to implant removal, healing, complications and shoulder function. As both treatment opinions are viable, the decision may depend on surgeons experience.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.