The consequences of independent functioning and public health care of fractures of the proximal humerus and their treatment: A prospective observational study

Several recent studies warn that the incidence of proximal humeral fractures is
rising with the expanding ageing population (Palvanen 2006, Kannus 2000,
Court-Brown 2006). Also, proximal humeral fractures are known to have severe
impact on upper extremity function (Calvo 2010) Therefore it can be expected
that the consequences, financially as well as workload, on public healthcare
will increase the coming decades. The magnitude of these consequences is likely
to be dependent of someone*s ability to function independently.
It is generally accepted that proximal humeral fractures with displacement of
more than 1 cm, or angulation (tilt) of more than 45* need operative treatment.
But besides the classic work of Neer in 1970, there is still little support for
this advice (Neer 1970, Foruria 2011). Furthermore, in proximal humeral
fractures, there are many different fracture patterns, (and classification
systems) and thus possible treatment strategies. The choice of which treatment
fits best for an individual patient depends on numerous factors, and with lack
of randomized comparative trials, decision making is not based on evidence, but
only on expert opinion with some support from retrospective studies (i.e. level
3 evidence) (Murray 2011, Handoll 2010).

The primary goal is to determine the degree of independent functioning of the
patient with a proximal humeral fracture.
A secondary goal is to evaluate all primary and secondary costs during the
rehabilitation period after a proximal humeral fracture.
A third goal is to relate healed proximal fractures to patient functioning in a
virtual dynamic environment (Krekel 2010).

A multicentre, prospective observational study.
Treatment options, either conservative or surgical will be made by the present
treatment protocols in these centers (i.e. usual care design).

The burden of this study consists in the duration of 3 standard outpatient
clinic visits which coincide with the regular outpatient visits. All patients
need to fill in the questionnaires (15 to 30 minutes per questionnaire), which
is extra compared to usual care. An extra CT scan will be made at the end of
the treatment period, to evaluate the healed proximal humeral fracture. The
patient will be exposed to a very low radiation dose of a maximum of 10 mGy.
This amount of radiation has a very little effect on the patient*s health (Hall
et all 2007).