Surgery Seldom Needed When Older Person Breaks Upper Arm: Study

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When an older patient breaks the upper arm, surgery is often no better than simply immobilizing the limb, according to a new study.

The British researchers say the findings are important, because they counter a growing trend toward surgery in these cases.

One expert in the United States agreed. “This well-done study provides further support for a nonsurgical approach for management of this commonly seen injury among older people in the emergency department,” said Dr. Robert Glatter, an emergency physician at Lenox Hill Hospital in New York City.

The new study was led by Dr. Amar Rangan of James Cook University Hospital in Middlesbrough, England. His team noted that fractures to the upper arm — the proximal humerus — now account for 5 percent to 6 percent of all broken bones in adults, and about 706,000 such fractures occurred worldwide in 2000.

Most proximal humerus fractures occur in people older than 65, and about half of the fractures are displaced, meaning that the two ends of the bones are separated from each other.

The use of surgery to treat such fractures is growing, but a recent review of clinical trial results found there was not enough evidence to determine whether surgery is better for patients than nonsurgical treatment.

The new study included 231 people, average age 66, with a displaced fracture in the arm near the shoulder. Some of the patients had surgery to repair the fracture, while others had their arms immobilized in a sling.

Rangan’s team found no significant differences in terms of pain, arm function or health-related quality of life between the two groups of patients after six, 12 and 24 months.

However, the risk profile was different: Ten medical complications occurred in the hospital among patients who had surgery, including two heart problems, two lung issues, two digestive events, and four others, the study found.

The bottom line, Rangan said, is that “these results do not support the trend of increased surgery for patients with displaced fractures of the proximal humerus.”

Glatter, who is also Lenox Hill’s director of sports medicine and traumatic brain injury, agreed with Rangan. “Given the potential risks for potentially life-threatening cardiac and respiratory complications in this older group of patients — with no significant differences in functional outcome after two years of follow up — medical providers should have a collaborative discussion to limit surgical intervention for this common injury,” he believes.

Dr. Jason Gould is chief of the Division of Orthopaedic Trauma at Winthrop-University Hospital in Mineola, N.Y.

He worried about “taking one study and generalizing it to the treatment of an entire class of fractures.” However, Gould agreed that in most cases, older patients with this fracture will do fine without surgery.

Nevertheless, a case-by-case approach is always warranted, he added. “The proximal humerus fracture is one that requires treating the whole patient — not just the X-ray,” Gould said. “Age, activity level, hand dominance, recreational activities [especially overhand activities] all play a role in the decision-making process in treating proximal humerus fractures.”

The study was published March 10 in the Journal of the American Medical Association.

More information

The U.S. National Library of Medicine has more about broken bones.

Source: HealthDay

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