By Veronica Hackethal, MD
Patients report no significant difference in 2-year outcomes for surgical vs nonsurgical treatment of displaced upper arm fractures, according to a UK randomized controlled trial published in the March 10 issue of JAMA.
“Among patients with displaced proximal humeral fractures involving the surgical neck, there was no significant difference between surgical treatment compared with nonsurgical treatment in patient-reported clinical outcomes over 2 years following fracture occurrence,” write Amar Rangan, MBBS, FRCS, from the James Cook University Hospital, Middlesbrough, United Kingdom, and colleagues. 
“These results do not support the trend of increased surgery for patients with displaced fractures of the proximal humerus,” they continue.
About 5% to 6% of all adult fractures involve breaking the proximal humerus. About half of these are displaced fractures, with about 77% including the surgical neck, the authors note. Most of these fractures occur in people older than 65 years, likely related to osteoporosis. Physicians have increasingly used surgery to mend these breaks, which adds to treatment costs. Data, however, remain inconclusive about whether surgery leads to better outcomes compared with nonsurgical treatment.