Please select the eligibility criteria that correspond to the clinical trial below.
Title: An International, Prospective, Randomized, Multicenter, Controlled Head-to-Head Comparison of Conservative, Plate Fixation and Prosthesis in Treatment of Displaced 2, 3, and 4 Part Fractures of Proximal Humerus of 60 Years and Older Patients
Brief Summary: This trial is designed to compare head-to-head conservative with operative treatment in 2 stratum. Stratum 1: In 2 part fractures the comparison is between conservative treatment and operative treatment with plate fixation with Philos. Stratum 2: In multi-fragmented fractures (MFF) meaning 3 and 4 part fractures, the comparison is between conservative treatment, operative treatment with Philos plate and operative treatment with Epoca prosthesis. Subgroup analysis will be performed in an effort to obtain limit values for specific treatment of different age and fracture groups. A cost-effectiveness analysis and comparison between different treatment modalities will be carried out. The primary outcome measure will be the DASH score and the secondary outcome measure the EQ-5D value. Recruitment period is 3 years and follow-up 2 years.


Options:
A: Inclusion Criteria:

Low energy AO/OTA group 11-B1.1, 11-B1.2 and 11-C1.1, 11-C3.1. Both B and C type includes subgroups: Displaced \[2\], Impacted \[3\] or Non impacted \[4\] from the universal modifiers list.

Exclusion Criteria:

Radiographic Mal-inclination Less than; varus 30°or valgus 45° Less than 50% contact between head fragment and meta-/diaphysis Head split fractures with more than 10% of the articular surface in the main head fragment.

Head split fractures (group 11-C3.2 and 11-C3.3) with more than 10% of the articular surface in the main head fragment.

Dislocation or fracture-dislocation of the gleno-humeral joint Pathological fracture

General

* Refuse to participate
* Age under 65 years of age, or over 85 years of age
* Serious poly-trauma or additional surgery
* Non-independent, drug/alcohol abuse or institutionalized (low co-operation)
* Contra-indications for surgery
* Does not understand written and spoken guidance in local languages
* Previous fracture with symptomatic sequelae in either shoulder
* Patients living outside the hospital's catchment area
B: 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.
C: Inclusion Criteria:

* Low energy proximal humeral displaced (more than 1 cm or 45 degrees) 2 part fracture where fracture line emerges through the surgical (or anatomical) neck
* Low energy proximal humeral displaced (more than 1 cm or 45 degrees) 3 or 4 part fracture

Exclusion Criteria:

* Refuse to participate the study
* Less than 60 years old
* Non-independent
* Dementia and/or institutionalized
* Does no understand written and spoken guidance in either Finnish or Swedish
* Pathological fracture or previous fracture in the same proximal humerus
* Serious intoxicant dependent, eg. In first aid breathalyzer shows more than 2‰
* Other operational injury in the same upper limb
* Major nerve injury (eg. Complete radialis- or delta palsy)
* Open fracture
* Multi-trauma or -fractured patient
* Fracture dislocation or head splitting fracture
* Undisplaced fracture
* Isolated tuberculum fracture
* Fracture has no precondition to ossify by conservative treatment (no bony contact between fracture parts or the humeral shaft is in contact with the articular surface)
* Treating surgeon considers patient unsuitable to attend the study on medical basis
* Cuff-arthropathy
D: 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

Answer: C