Evidence-based orthopedics and the myth of restoring the anatomy

Figures & data

68-year-old female suffering an impacted 2-part fracture of the proximal humerus. Radiographs were taken on admission and after 5 months. Clinical photos were taken after 5 months. Pain-free shoulder function was obtained after 3 months. In this case intuition will tell most orthopedic surgeons to restore the anatomy, most likely by open reduction and internal fixation with a locking plate. Best evidence from randomized trials does not support this decision (Rangan et al. 2015, Launonen et al. 2019). How to act?

Rangan A, Handoll H, Brealey S, Jefferson L, Keding A, Martin B C, et al. Surgical vs nonsurgical treatment of adults with displaced fractures of the proximal humerus: the PROFHER randomized clinical trial. JAMA 2015; 313(10): 1037–47.

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Launonen A P, Sumrein B O, Reito A, Lepola V, Paloneva J, Jonsson K B, et al. Operative versus non-operative treatment for 2-part proximal humerus fracture: a multicenter randomized controlled trial. PLoS Med 2019; 16(7): e1002855.

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