BMJ 2015;350:h1669 doi: 10.1136/bmj.h1669 (Published 30 March 2015)
Page 1 of 1
Letters
LETTERS DISPLACED FRACTURE OF UPPER ARM
Not all patients with displaced proximal humerus fractures are suitable for sling treatment Kanthan Theivendran upper limb fellow, Sami Hassan speciality trainee year 6, Amol Tambe consultant upper limb and orthopaedic surgeon, Tim Cresswell consultant upper limb and orthopaedic surgeon, David I Clark consultant upper limb and orthopaedic surgeon Royal Derby Hospital, Derby DE22 3NE, UK
We commend the PROFHER Randomised Clinical Trial collaborators and the patients involved in the landmark study reported by Wise in news.1 It is rare to complete such a large randomised trial of surgery, let alone surgery on patients with trauma.
However, we would like to draw attention to the finer details published in JAMA, particularly the study’s exclusion criteria. In total, 1000 patients were excluded, of whom 87 had a “clear indication for surgery” and 101 had associated dislocations. It is common practice for a large proportion of patients with associated dislocations to have surgery. Thus, 188 patients who were excluded from the trial probably needed surgery. This number is higher than the number randomised to surgery (125 patients). Therefore such headline news as “Surgery no better than a simple sling” is misleading because a proportion of patients who needed surgery were excluded from the trial. Instead, the
trial suggests that surgery has a role in specific patients with displaced proximal fractures of the humerus that were deemed to have a “clear indication for surgery.”
This excellent randomised pragmatic trial does show that, for the “average” patient pre-selected through the inclusion criteria, no significant difference is seen between surgical treatment and non-surgical treatment for the primary outcome measure. Readers should not conclude that all patients with displaced fractures of the proximal humerus have equal outcomes after sling treatment compared with surgery. Competing interests: None declared. 1
Wise J. Surgery is no better than a simple sling for displaced fracture of upper arm, study finds. BMJ 2015;350:h1304. (11 March.)
Cite this as: BMJ 2015;350:h1669 © BMJ Publishing Group Ltd 2015
[email protected] For personal use only: See rights and reprints http://www.bmj.com/permissions
Subscribe: http://www.bmj.com/subscribe
Page 1 of 1
Letters
LETTERS DISPLACED FRACTURE OF UPPER ARM
Not all patients with displaced proximal humerus fractures are suitable for sling treatment Kanthan Theivendran upper limb fellow, Sami Hassan speciality trainee year 6, Amol Tambe consultant upper limb and orthopaedic surgeon, Tim Cresswell consultant upper limb and orthopaedic surgeon, David I Clark consultant upper limb and orthopaedic surgeon Royal Derby Hospital, Derby DE22 3NE, UK
We commend the PROFHER Randomised Clinical Trial collaborators and the patients involved in the landmark study reported by Wise in news.1 It is rare to complete such a large randomised trial of surgery, let alone surgery on patients with trauma.
However, we would like to draw attention to the finer details published in JAMA, particularly the study’s exclusion criteria. In total, 1000 patients were excluded, of whom 87 had a “clear indication for surgery” and 101 had associated dislocations. It is common practice for a large proportion of patients with associated dislocations to have surgery. Thus, 188 patients who were excluded from the trial probably needed surgery. This number is higher than the number randomised to surgery (125 patients). Therefore such headline news as “Surgery no better than a simple sling” is misleading because a proportion of patients who needed surgery were excluded from the trial. Instead, the
trial suggests that surgery has a role in specific patients with displaced proximal fractures of the humerus that were deemed to have a “clear indication for surgery.”
This excellent randomised pragmatic trial does show that, for the “average” patient pre-selected through the inclusion criteria, no significant difference is seen between surgical treatment and non-surgical treatment for the primary outcome measure. Readers should not conclude that all patients with displaced fractures of the proximal humerus have equal outcomes after sling treatment compared with surgery. Competing interests: None declared. 1
Wise J. Surgery is no better than a simple sling for displaced fracture of upper arm, study finds. BMJ 2015;350:h1304. (11 March.)
Cite this as: BMJ 2015;350:h1669 © BMJ Publishing Group Ltd 2015
[email protected] For personal use only: See rights and reprints http://www.bmj.com/permissions
Subscribe: http://www.bmj.com/subscribe
