ArticleJB & JS open access
Let Us Agree to Disagree on Operative Versus Nonoperative Treatment for Proximal Humerus Fractures: A Multicenter International Prospective Cohort Study of Gray-Zone, Clinical Equipoise Fractures.
Article in JB & JS open access. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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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.
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Who cites it
3 citing papers in PubMed.
- What is the preferred timing for surgery after proximal humerus fractures: an e-modified Delphi Survey Study.JSES reviews, reports, and techniques · 2026Article
- Locking plate fixation for proximal humerus fractures: are four proximal screws adequate? A clinical and radiological analysis of 105 consecutive cases.Archives of orthopaedic and trauma surgery · 2026Article
- Delphi method consensus on radiographic characteristics influencing management decisions for proximal humerus fracture.Journal of orthopaedic surgery and research · 2025Article
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Authors and funding
12 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background: Internationally, the optimal treatment strategy of proximal humerus fractures remains much debated. Methods: To investigate whether operative treatment of displaced proximal humerus fractures is superior to nonoperative treatment, this international multicenter prospective natural experiment based on clinical equipoise was performed. Two hundred twenty-six patients with acute proximal humerus fractures presenting from July 2020 to March 2022 were included after expert panel evaluation, consisting of Dutch and Swiss surgeons with diverse ideas on optimal treatment. Patients were included when no consensus on optimal treatment was reached i.e., clinical equipoise. Follow-up was completed after 1 year (n = 191 [84%]). The primary outcome was Quick Disability of the Arm, Shoulder, and Hand (QuickDASH) after 1 year. Secondary outcomes included QuickDASH at 6 weeks and EQ5D, Subjective Shoulder Value (SSV), Numeric Rating Scale (NRS) for pain at 6 weeks and 1 year. Results: No difference in QuickDASH score after 1 year (12.8 vs. 16.2, p = 0.73) was found. At 6 weeks, operative treatment resulted in lower NRS (4.3 vs. 3.0, p < 0.001), higher EQ5D (0.59 vs. 0.67, p = 0.011), and higher SSV (40.9 vs. 51.4, p = 0.005). At 1 year, operative treatment resulted in higher SSV (72.1 vs. 83.7, p = 0.002), while EQ5D was comparable (0.87 vs. 0.85, p = 0.95). Conclusion: No difference between treatments was observed in the primary outcome. Patient-tailored care may still include counseling operative treatment to patients to reduce short-term pain and/or facilitate early return to sport/work in young active patients. Level of Evidence: Level II. See Instructions for Authors for a complete description of levels of evidence.
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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.