Has the ProFHER Trial Changed the Orthopaedic Surgeons' Decision Making and Treatment of Proximal Humeral Fractures?

Background: To explore the impact of the ProFHER trial on initial decision making in the management of proximal humerus fractures at a district general hospital (DGH).

Material And Methods: Retrospective review of all proximal humerus fractures at a single DGH during 1 year before ProFHER (2014) and 1 year following publication (2018). Data related to demographics, fracture pattern, and management was collected from electronic patient records and analysed.

Results: 52 patients in 2014 and 70 patients in 2018 met the inclusion criteria. There was no significant difference in demographics or fracture classification. Fewer patients were admitted from Accident and Emergency in 2018 (44% vs 55%). Of patients admitted, there was no significant difference between the proportion referred to a shoulder surgeon (SS) (27.5% vs 30%). In patients seen initially in fracture clinic by a non-shoulder surgeon (NSS), significantly fewer were referred for a SS opinion in 2018 (6.7%) vs 2014 (50%). Computed tomography was requested in 5/52 cases (9.6%) in 2014 and 8/70 cases (11.4%) in 2018, all cases involved an SS. Significantly more patients (14/52, 27%) were managed surgically in 2014 compared to 2018 (10/70, 14%). All patients were discharged with the exception of 1 patient in each group who required later surgical intervention.

Conclusions: 1. The widely disseminated ProFHER trial is likely to have influenced contemporary clinical practice. 2. This study shows non-shoulder specialists are more likely to manage these patients conservatively and without the involvement of shoulder surgeons post ProFHER. 3. This impact on clinical outcomes requires further research.