![]() ![]() Thus, there were clearly surgeons participating in this study who felt uneasy about entering patients into a randomisation process whereby the patient may be allocated to nonoperative treatment. Plus, of greatest concern, there were a number of patients eligible for the ProFHER study that were excluded because they had “clear indications for surgery”. It is hard to imagine this small proportion of patients being representative of all fractures of the proximal humeral at participating centres over this time frame. Also, in the ProFHER study 66 surgeons operated on 125 patients over a two and a half year period, i.e., less than one patient per surgeon per year. The number of severely fractured (Neer 4-part) in the ProFHER trial was much lower than the 25% in the normal population, suggesting that generalisation of the results of the ProFHER trial may not be appropriate. However, in reality the solution may not be that simple. At 2 and 5 years after their injury, the results of nonoperative and operative treatment were similar, indicating that there was no clear advantage to surgery. Adults with a displaced fracture of the proximal humerus were entered into the trial. You should be aware of the ProFHER Trial, the results of which were published in the medical literature in 2015. These injuries tend to take a year to recover from, sometimes longer. There are ways we can try and reduce it but not eliminate it. Stiffness is a consequence of these fractures. I would say now however that some restriction, whatever the treatment, is normal following such an injury. If you are young and perhaps a manual worker or a sporty-type then perhaps surgery to try and reconstruct the fracture back to something that resembles natural anatomy might be more desirable in order to stand you in the best position for movement recovery. This may mean accepting that your shoulder fracture should heal, but you may be left with a lot of restriction of movement. If you have complex medical problems and anaesthesia is thought to be very high risk for you then it is likely that nonoperative treatment will be preferable. All other injuries CAN be managed without surgery, but it is a matter of what your outcome will be like. Those are open fracture (where the fracture ends have pierced the skin) or nerve or blood vessel injury. There are really only a couple of absolute indications for surgery for this fracture. It may be clear from your injury whether you should have a sling for a few weeks before mobilising (moving) the shoulder gradually and allowing the fracture to heal naturally (nonoperative treatment), or whether surgery is either necessary or perhaps preferable. Once you come to clinic you will be given the chance to discuss your shoulder with a specialist in these injuries. It is better to wear the sling during the night in bed. If even this is too painful the wear the sling under the clothes. Feed your clothes onto your broken limb first then onto the unbroken side, with help. You don’t need to wear the sling under your clothes. It is ok to remove the sling for short periods to wash and dress. You may be supplied with a blue ‘polysling’ which are more substantial but don’t tend to allow gravity to ‘pull the fracture out’ quite so much. This mean that by the time you attend clinic and have another X-ray, your fracture may look slightly better, and it may even mean you can avoid surgery. By supporting the wrist and not the elbow, the action of gravity on the arm tends to pull the fracture out straight a little. This may feel like inadequate treatment of your significant injury but there is a good reason for this. The sling you are provided with may only be a pink foam sling that goes around your neck and around the wrist. Extensive bruising down the arm, even beyond the elbow, is common and can be alarming but it does settle in 2-3 weeks. It is uncommon to get paresthesia (pins and needles sensation) in the arm or hand with this injury. It’s a good idea to remove rings from fingers early on after injury as they can be difficult to remove after a day or so and they can compromise the blood supply to your fingers. This will settle in time but can take 4-6 weeks. The pain will be significant for about the first 3 weeks and is often accompanied by extensive bruising around the shoulder and down the arm and the arm will swell. You are then likely to be sent home from the Emergency Department and sent a clinic appointment. If a doctor suspects that you may have fractured (broken) your shoulder, you will be sent for an X-ray and then placed in a sling. ![]()
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