Ruben Hoepelman (Utrecht / NL), Yassine Ochen (Utrecht / NL), Frank Beeres (Lucerne / CH), Herman Frima (Alkmaar / NL), Christoph Sommer (Chur / CH), Christian Michelitsch (Chur / CH), Reto Babst (Lucerne / CH), Isabelle Buenter (Lucerne / CH), Detlef van der Velde (Utrecht / NL), Egbert-Jan Verleisdonk (Utrecht / NL), Rolf Groenwold (Leiden / NL), Marijn Houwert (Utrecht / NL), Mark van Heijl (Utrecht / NL)
Abstract text (incl. references and figure legends)
Introduction The optimal treatment strategy for proximal humerus fractures remains much debated. The decision for operative or nonoperative treatment is strongly influenced by patient factors and training of the treating surgeons. Although randomized controlled trials (RCT) remain the gold standard for comparing interventions, the patient population encountered in daily clinical practice differs from the highly selective patients enrolled in RCTs. A natural experiment (NE) design could be the solution. A NE, based on practice variation, can be considered when recommendations for treatment strategies are largely influenced by training of the surgeons. For instance, a NE can be set up by comparing two countries with a predominant preference for operative or nonoperative treatment. Therefore, this study aims to compare operative and nonoperative treatment of proximal humeral fractures for those patients where disagreement exists about the optimal treatment strategy.
Methods This international multicenter cohort study includes five hospitals in two countries (A and B) with a predominant preference for operative or nonoperative treatment. All patients 18 years and older with displaced proximal humerus fractures were eligible for expert panel evaluation. The expert panel consisted of three trauma surgeons from each country. Patients were included when experts from one country (A) disagreed with the treatment started in the other country (B), hereby only including patients about whom there was proven disagreement about the optimal treatment strategy. The primary outcome was the Q-DASH measured at one year.
Results Follow-up will be completed in March 2023, therefore, results will be available during the ESTES congress.
Conclusion This study will help us determine which treatment strategy is preferred in patients where there is proven disagreement about optimal management. Furthermore, this NE design can serve as an alternative for RCTs, when those are not feasible.
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This study was funded by DePuy Synthes for the completion of the study. No author personally received specific awards. Grant number DPS-TCMF-2019-033). The organization has not been involved in the drafting of this study. They will not be involved in study design, data collection, analysis or the decision to publish the final manuscript.