The older patient has a fracture of the upper arm! What to do? Hold the surgery! A study of 231 people with an average age of 66, each of whom had a displaced fracture of the arm near the shoulder, found that a sling was better for them than was surgery.
Sling Beats Surgery for Broken Humerus
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Some of the 231 had surgery to repair their arms, others had their arms immobilized and hung in a sling. At the end of 2, 12 and 24 months researchers found no significant differences in terms of pain, arm function or quality of life between the two groups.
However they did exhibit a difference. Those who had surgery experienced 10 medical complications including heart problems, lung issues, and digestive events. Those with their arms in slings experienced none of these problems. “These results do not support the trend of increased surgery for patients with displaced fractures of the proximal humerus, ” the authors wrote. The study was published in the March 10 issue of the Journal of the American Medical Association.
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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