The common course of action for a displaced shoulder fracture is surgery that requires plates and screws to put the pieces back together. However, new research reveals a more conservative approach that includes just immobilizing the shoulder in a sling to could be just as effective.
Researchers from Aarhus University in Denmark studied 88 patients over the age of 60 who had suffered shoulder fractures that caused the bones to be displaced. It is common for the bones in the shoulder break and shift in a fall, especially among the elderly.
Half of the patients underwent surgery to join the pieces with plates and screws and the other half had their arm just supported by a sling. The report in the journal PLOS Medicine detailed how all 88 patients underwent supervised rehabilitation with a physiotherapist and were tracked for a period of two years.
To the surprise of many, both groups had healed equally as well by the three-week mark. Researchers also found even after the one-year mark there was no difference for the patients when it came to their own assessment of function, pain and quality of life regardless of the type of treatment.
"The results are thought-provoking in that there is no difference between patients who underwent surgery and those who didn't,” said lead researcher Inger Mechlenburg. “Those who underwent surgery don't have better shoulder function or less pain than those who didn't.”
Mechlenburg believes changes in treatment protocol should be considered as a result. “Our conclusion must therefore be that the least intrusive form of treatment shows itself to be the best," she says. “As there is no difference in the patients' ability to carry out daily chores, their level of pain or quality of life with or without the displaced shoulder fracture surgery, then treatment with only a sling should be preferred, as the patients thereby avoid surgery-related pain and complications.”
However, Mechlenburg knows it will take time to change people’s minds regarding the current standard of care. "It's difficult to change clinical practice, especially if it's a question of going from more to less," she said. "The fundamental starting point of the study was to find the best form of treatment for precisely this type of injury. We've provided evidence that there is no beneficial effect of surgery, and the various healthcare services should address this fact."