Background
Although increasingly used, the benefit of surgical treatment of displaced 2-part proximal humerus fractures has not been proven. This trial evaluates the clinical effectiveness of surgery with locking plate compared with non-operative treatment for these fractures.
Methods and findings
The NITEP group conducted a superiority, assessor-blinded, multicenter randomized trial in 6 hospitals in Finland, Estonia, Sweden, and Denmark. Eighty-eight patients aged 60 years or older with displaced (more than 1 cm or 45 degrees) 2-part surgical or anatomical neck proximal humerus fracture were randomly assigned in a 1:1 ratio to undergo either operative treatment with a locking plate or non-operative treatment. The mean age of patients was 72 years in the non-operative group and 73 years in the operative group, with a female sex distribution of 95% and 87%, respectively. Patients were recruited between February 2011 and April 2016. The primary outcome measure was Disabilities of Arm, Shoulder, and Hand (DASH) score at 2-year follow-up. Secondary outcomes included Constant–Murley score, the visual analogue scale for pain, the quality of life questionnaire 15D, EuroQol Group’s 5-dimension self-reported questionnaire EQ-5D, the Oxford Shoulder Score, and complications. The mean DASH score (0 best, 100 worst) at 2 years was 18.5 points for the operative treatment group and 17.4 points for the non-operative group (mean difference 1.1 [95% CI −7.8 to 9.4],
p =
0.81). At 2 years, there were no statistically or clinically significant between-group differences in any of the outcome measures. All 3 complications resulting in secondary surgery occurred in the operative group. The lack of blinding in patient-reported outcome assessment is a limitation of the study. Our assessor physiotherapists were, however, blinded.
Conclusions
This trial found no significant difference in clinical outcomes at 2 years between surgery and non-operative treatment in patients 60 years of age or older with displaced 2-part fractures of the proximal humerus. These results suggest that the current practice of performing surgery on the majority of displaced proximal 2-part fractures of the humerus in older adults may not be beneficial.
Trial registration
ClinicalTrials.gov
NCT01246167
.
The extensor digitorum brevis manus muscle is a rare accessory hand muscle. It presents as a swelling on the dorsum of the hand and is often misdiagnosed as a ganglion. In symptomatic cases the treatment is division of the extensor retinaculum or ablation of the muscle.
A case of pneumococcal pyomyositis of the brachial and shoulder region is presented. A bacteremic right lower lobe pneumonia was the source of infection. The spread of pneumococci was presumed to be blood-borne, presenting with cellulitis over the right shoulder region, progressing over 5 days to abscess formation in the right biceps muscle and right shoulder joint despite adequate antibiotic treatment.
A 30 year old woman presented with pain in her right wrist a year after operation for de Quervain's tenosynovitis. Magnetic resonance imaging showed avascular necrosis of the scaphoid without loss of volume. She was instructed to wear a brace on her wrist while working. A year later she was free of symptoms but the scan was unchanged. Avascular necrosis of the scaphoid not associated with injury is extremely rare.
A 40-year-old woman presented with a lesion on the first phalanx of her right thumb, which on radiography appeared to be a cystic lesion. This was treated with curettage and bone graft but recurred a year later. It was treated in the same way, and 18 months later there has been no sign of recurrence. Histological examination confirmed that it was an aneurysmal bone cyst.
Background:The purpose of the present study was to investigate whether ultrasonography can be used as a diagnostic tool to exclude extremity fractures in adults.Methods:This prospective comparative study involved 91 patients (age, ≥18 years) who had been referred by general practitioners for a conventional radiographic examination of a suspected extremity fracture. No additional clinical examination was performed. Ultrasound examination was consistently carried out prior to conventional radiographic examination, which was regarded as the gold standard. At the end of the study, the positive scans were confirmed by a specialist who was highly skilled in ultrasonography.Results:The prevalence of fractures in the study population was 27%. Ultrasonography had a sensitivity of 92%, a specificity of 94%, a positive predictive value of 85%, a negative predictive value of 97%, a positive likelihood ratio of 15.33, and a negative likelihood ratio of 0.085. There seemed to be no association between the anomalous results and patient age or the specific anatomical region of the fracture.Conclusions:The present study indicates that ultrasonography, when performed and interpreted by experienced ultrasonographers, has high accuracy for the diagnosis of a suspected extremity fracture. No systematic differences were found between the results of radiography and ultrasonography, and ultrasonography showed a high sensitivity and specificity.Level of Evidence:Diagnostic Level II. See Instructions for Authors for a complete description of levels of evidence.
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