Please select the eligibility criteria that correspond to the clinical trial below.
Title: Effect of Osteosynthesis, Primary Hemi-arthroplasty, and Non-surgical Management for Displaced Four-part Fractures of the Proximal Humerus in Elderly: a Multi-centre, Randomised Clinical Trial
Brief Summary: Displaced four-part fractures are among the most severe injuries of the proximal humerus. The optimal treatment is disputed and published data are inadequate for evidence-based decision making.

The investigators aim to: 1) compare the effect of angle-stable plate osteosynthesis and non-surgical management, 2) compare the effect of primary hemiarthroplasty with both osteosynthesis and non-surgical management, 3) study prognostic differences between 'valgus impacted' and 'classical' four-part fracture patterns.

The investigators will conduct a randomised, multi-centre, clinical trial including patients from ten national shoulder units within a two year period. Patients will be randomised to non-surgical treatment, hemiarthroplasty or angle-stable plate osteosynthesis. All patients will receive a standardised three-month rehabilitation program of supervised physiotherapy. Patients will be followed at least one year and will be assessed blindly according to a standardised evaluation protocol including Constant Disability Scale, Oxford Shoulder Score, and Short Form-36.


Options:
A: Inclusion Criteria:

* surgical treatment of the shoulder joint after upper arm fracture classified as type AO 11
* movement-stable fracture
* Inclusion between the fourth and the seventh week after surgery

Exclusion Criteria:

* limited cognition as defined by a score in Short-Orientation-Memory-Concentration Test (SOMC) less than 10 points
* inadequate level of pain during movement of the affected shoulder joint (pain score \>5 on a visual analogue pain scale)
* strongly limited vision or hearing
* heart failure (New York Heart Association stage III-IV) or COPD (Chronic Obstructive Pulmonary Disease) Gold stage III-IV
* walking speed \<0.8m/sec
* isolated tuberculum majus fracture of the humerus (AO 11, A1)
* fractures with involvement of the glenoid cavity
* double fractures
* injury of the plexus or the axillaris nerve
B: Inclusion Criteria:

* Displaced four-part fracture of the proximal humerus
* Mentally alert
* Physically fit for surgery and rehabilitation (ASA-group 1-3)
* Informed written consent
* Operation can be conducted within 2 weeks of injury

Exclusion Criteria:

* Fracture-dislocations
* Head-splitting fractures
* Previous shoulder surgery on injured side
* Chronic shoulder pain
* Abuse problems
* Patients unable to understand instructions in Danish
C: Inclusion Criteria:

* proximal humerus fracture of AO group B2 or C2 (displaced fracture of extra-articular or articular, bifocal type) admitted in hospital

Exclusion Criteria:

* aged less than 60 year
* patients of non-Scandinavian ethnicity
* previous history of injury or illness of the injured or contralateral shoulder
* injury of other part of the humerus or the contralateral upper extremity,
* alcohol- or drug abuse
* dementia or neurological diseases
* severe cardiovascular disease that would contraindicate surgery
D: Inclusion Criteria:

* Proximal humerus fracture (without surgery)
* Return home after discharge from hospital
* Be able to exercise;
* Have sufficient verbal and written understanding to participate to telerehabilitation sessions, and to be able complete the questionnaires;
* Have access to high-speed Internet at home.

Exclusion Criteria:

* Presence of intra-articular type proximal humerus fracture, which can lead to a greater risk of complication and may require a longer recovery time
* Fracture surgery as a treatment
* Presence of any other type of upper body fracture which can interfere with rehabilitation.

Answer: B