Evidence map›Paper›PMID 31977825›Full record

Trial reportThe Journal of bone and joint surgery. American volume2020

Reverse Shoulder Arthroplasty Is Superior to Plate Fixation at 2 Years for Displaced Proximal Humeral Fractures in the Elderly: A Multicenter Randomized Controlled Trial.

Alexander Nilsskog Fraser, Jonas Bjørdal, Tone Mehlum Wagle, Anna Cecilia Karlberg, Odd Arve Lien, Lars Eilertsen, Konrad Mader, Hilde Apold, Leif Børge Larsen, Jan Erik Madsen and 1 more

Erratum issued Registry-linked trialOpen access · hybridAbstract readComparative StudyMulticenter StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in The Journal of bone and joint surgery. American volume, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. It is linked to trial NCT01737060 (Clinical Investigation for Fractures of the Proximal Humerus in Elderly Patients. A Randomized Study of Two Surgical Treatments), which is not on this map. Cited by 98 papers, 10 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
98citing papers in PubMed, 10 pooled it
21.6field-weighted citation impact, top 1% of its field
1 · What the graph read from 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.

2 · The registry

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.

NCT01737060 nacompletednot on this map

Clinical Investigation for Fractures of the Proximal Humerus in Elderly Patients. A Randomized Study of Two Surgical Treatments: Reverse Total Shoulder Arthroplasty Versus Angular Stable Device Philos

TypeinterventionalSponsorOslo University HospitalRan2013 to 2022Enrolled124ConditionsProximal Humeral Fractures, AO/OTA (2007) Group B2 and C2ArmsReverse total shoulder arthroplasty
3 · Its place in the literature

Who cites it

98 citing papers in PubMed, 10 syntheses or guidelines pooled it, 183 citations in OpenAlex.

  1. Pooled it
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  9. Surgical treatment of proximal humerus fractures: a systematic review and meta-analysis.European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2023
    Pooled it
  10. Interventions for treating proximal humeral fractures in adults.The Cochrane database of systematic reviews · 2022
    Pooled it
  11. [Clinical study of reverse total shoulder arthroplasty versus open reduction and internal plate fixation for treatment of Neer three/four-part proximal humeral fractures in elderly].Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery · 2025
    Trial
  12. External validity in a multicenter randomized clinical trial of proximal humeral fractures: the DelPhi trial.European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2022
    Trial
  13. Article
  14. Article
  15. Clinical validation of the DRoPH score: a preoperative tool for estimating reduction difficulty in proximal humerus fractures.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2026
    Article
  16. Observational
  17. Reverse Total Shoulder Arthroplasty After Proximal Humerus Fracture Using a Novel FiberTape Cerclage Tuberosity Fixation Technique.Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews · 2026
    Article
  18. Article
  19. Article
  20. Review

38 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

11 authors at 7 institutions in 2 countries.

Alexander Nilsskog FraserDivision of Orthopaedic Surgery (A.N.F., T.M.W., J.E.M., and T.F.), and Division of Radiology and Nuclear Medicine, Department of Musculoskeletal Radiology (A.C.K.), Oslo University Hospital, Oslo, Norway.ORCID 0000-0002-3258-3365
Jonas BjørdalDepartment of Orthopedic Surgery, Østfold Hospital Trust, Grålum, Norway.ORCID 0000-0001-5364-7172
Tone Mehlum WagleDivision of Orthopaedic Surgery (A.N.F., T.M.W., J.E.M., and T.F.), and Division of Radiology and Nuclear Medicine, Department of Musculoskeletal Radiology (A.C.K.), Oslo University Hospital, Oslo, Norway.ORCID 0000-0003-2575-6819
Anna Cecilia KarlbergDivision of Orthopaedic Surgery (A.N.F., T.M.W., J.E.M., and T.F.), and Division of Radiology and Nuclear Medicine, Department of Musculoskeletal Radiology (A.C.K.), Oslo University Hospital, Oslo, Norway.ORCID 0000-0003-2227-0362
Odd Arve LienDepartment of Orthopedic Surgery, Vestre Viken Hospital Trust, Bærum Hospital, Bærum, Norway.ORCID 0000-0003-4866-9830
Lars EilertsenDiakonhjemmet Hospital, Oslo, Norway.ORCID 0000-0003-3022-7858
Konrad MaderDivision of Hand, Forearm and Elbow Traumatology, Department of Trauma, Hand and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.ORCID 0000-0003-4514-4836
Hilde ApoldDepartment of Orthopedic Surgery, Telemark Hospital, Skien, Norway.ORCID 0000-0001-9227-2959
Leif Børge LarsenDepartment of Orthopedic Surgery, Vestfold Hospital Trust, Tønsberg, Norway.ORCID 0000-0003-3853-5791
Jan Erik MadsenDivision of Orthopaedic Surgery (A.N.F., T.M.W., J.E.M., and T.F.), and Division of Radiology and Nuclear Medicine, Department of Musculoskeletal Radiology (A.C.K.), Oslo University Hospital, Oslo, Norway.ORCID 0000-0002-9002-1213
Tore FjalestadDivision of Orthopaedic Surgery (A.N.F., T.M.W., J.E.M., and T.F.), and Division of Radiology and Nuclear Medicine, Department of Musculoskeletal Radiology (A.C.K.), Oslo University Hospital, Oslo, Norway.ORCID 0000-0002-4995-9891
Oslo University Hospital · NODiakonhjemmet Hospital · NOØstfold Hospital Trust · NOSykehuset i Vestfold · NOTelemark Hospital · NOUniversität Hamburg · DEVestre Viken Hospital Trust · NO

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAlmost one-third of patients with proximal humeral fractures are treated surgically, and the number is increasing. When surgical treatment is chosen, there is sparse evidence on the optimum method. The DelPhi (Delta prosthesis-PHILOS plate) trial is a clinical trial comparing 2 surgical treatments. Our hypothesis was that reverse total shoulder arthroplasty (TSA) yields better clinical results compared with open reduction and internal fixation (ORIF) using an angular stable plate.

methodsThe DelPhi trial is a randomized controlled trial comparing reverse TSA with ORIF for displaced proximal humeral fractures (OTA/AO types 11-B2 and 11-C2) in elderly patients (65 to 85 years of age). The primary outcome measure was the Constant score at a 2-year follow-up. The secondary outcome measures included the Oxford Shoulder Score and radiographic evaluation. Results were reported as the mean difference with 95% confidence interval (CI). The intention-to-treat principle was applied for crossover patients.

resultsThere were 124 patients included in the study. At 2 years, the mean Constant score was 68.0 points (95% CI, 63.7 to 72.4 points) for the reverse TSA group compared with 54.6 points (95% CI, 48.5 to 60.7 points) for the ORIF group, resulting in a significant mean difference of 13.4 points (95% CI, 6.2 to 20.6 points; p < 0.001) in favor of reverse TSA. When stratified for fracture classification, the mean score was 69.3 points (95% CI, 63.9 to 74.7 points) for the reverse TSA group and 50.6 points (95% CI, 41.9 to 59.2 points) for the ORIF group for type-C2 fractures, which yielded a significant mean difference of 18.7 points (95% CI, 9.3 to 28.2 points; p < 0.001). In the type-B2 fracture group, the mean score was 66.2 points (95% CI, 58.6 to 73.8 points) for the reverse TSA group and 58.5 points (95% CI, 49.6 to 67.4 points) for the ORIF group, resulting in a nonsignificant mean difference of 7.6 points (95% CI, -3.8 to 19.1 points; p = 0.19).

conclusionsAt a 2-year follow-up, the data suggested an advantage of reverse TSA over ORIF in the treatment of displaced OTA/AO type-B2 and C2 proximal humeral fractures in elderly patients. LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Indexed as

Bone PlatesAgedAged, 80 and overArthroplasty, Replacement, ShoulderFemaleFollow-Up StudiesFracture Fixation, InternalHumansIntention to Treat AnalysisMaleOpen Fracture ReductionShoulder FracturesTreatment Outcome

Identifiers

PMID31977825
PMCPMC7508281
OpenAlexW3003109020

What OpenQuestion holds

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LicenceCC BY-NC-ND
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Registered trials

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.