ArticlePLoS medicine2019
Operative versus non-operative treatment for 2-part proximal humerus fracture: A multicenter randomized controlled trial.
Article in PLoS medicine, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT01246167 (An International, Prospective, Randomized, Multicenter, Controlled Head-to-Head Comparison of Conservative, Plate Fixation and Prosthesis in Treatment of Displaced 2, 3, and 4 Part Fractures of Proximal Humerus of 60 Years and Older Patients), which is not on this map. Cited by 53 papers, 8 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
An International, Prospective, Randomized, Multicenter, Controlled Head-to-Head Comparison of Conservative, Plate Fixation and Prosthesis in Treatment of Displaced 2, 3, and 4 Part Fractures of Proximal Humerus of 60 Years and Older Patients
Who cites it
53 citing papers in PubMed, 8 syntheses or guidelines pooled it, 111 citations in OpenAlex.
- Quality assessment of prospective cohort and randomized controlled trials evaluating surgical treatment of proximal humerus fractures: a systematic review.European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2025Pooled it
- Is surgical treatment better than non-surgical treatment for proximal humeral fracture in elderly people? A meta-analysis and meta-regression.European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2025Pooled it
- Outcomes following reverse total shoulder arthroplasty vs operative fixation for proximal humerus fractures: a systematic review and meta-analysis.Annals of the Royal College of Surgeons of England · 2024Pooled it
- Comparative efficacy and safety of medical treatments for proximal humerus fractures: a systematic review and network meta-analysis.BMC musculoskeletal disorders · 2024Pooled it
- Quality of Life and Pain after Proximal Humeral Fractures in the Elderly: A Systematic Review.Medicina (Kaunas, Lithuania) · 2023Pooled it
- The fragility and reverse fragility indices of proximal humerus fracture randomized controlled trials: a systematic review.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2022Pooled it
- Interventions for treating proximal humeral fractures in adults.The Cochrane database of systematic reviews · 2022Pooled it
- Use of different devices for surgical treatment of proximal humerus fractures in adults: a systematic review.Acta bio-medica : Atenei Parmensis · 2021Pooled it
- Trial
- Cost-effectiveness analysis of locking nail compared with locking plate for displaced 3- and 4-part proximal humerus fractures: a secondary analysis of a randomized trial comparing the Multiloc nail and PHILOS plate.Acta orthopaedica · 2025Trial
- Early functional improvements using continuous passive motion therapy after angular-stable plate osteosynthesis of proximal humerus fractures - results of a prospective, randomized trial.Journal of orthopaedic surgery and research · 2024Trial
- Surgery with locking plate or hemiarthroplasty versus nonoperative treatment of 3-4-part proximal humerus fractures in older patients (NITEP): An open-label randomized trial.PLoS medicine · 2023Trial
- Management of proximal humerus fractures: a review of contemporary treatment options.JSES reviews, reports, and techniques · 2026Review
- Longer hospital stay but similar one-year mortality and readmission after combined proximal humerus and proximal femur fragility fractures: a Propensity-Score-Matched Cohort Study.Archives of orthopaedic and trauma surgery · 2026Article
- Article
- Imaging-based assessment of fracture stability does not reliably predict outcomes in patients with two-part proximal humeral fractures and may lead to unnecessary surgeries.EFORT open reviews · 2026Review
- The impact of prior level of care on the course of proximal humeral fractures in older patients: an analysis based on health insurance claims data.BMC health services research · 2026Article
- Delphi method consensus on radiographic characteristics influencing management decisions for proximal humerus fracture.Journal of orthopaedic surgery and research · 2025Article
- Long-term functional outcomes of non-operative treatment in patients with humeral surgical neck fractures.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2025Article
- Article
Corrections and comments
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Authors and funding
19 authors at 7 institutions in 4 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundAlthough 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
findingsThe 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.
conclusionsThis 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 registrationClinicalTrials.gov NCT01246167.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.