Please select the eligibility criteria that correspond to the clinical trial below.
Title: Health and Cost Consequenses of Surgical Versus Conservative Treatment for a Comminuted Humerus Fracture. Do Interlocking Plate Surgery Benefit Displaced Proximal Humerus Fractures? A Randomized Clinical Trial
Brief Summary: 1. Do a standardized surgical treatment of unstable displaced proximal humerus fracture in patients aged over 60 compared to a standardized conservative treatment gain a better functional outcome after one year?
2. Do surgical treatment gain more QALY than conservative treatment after one year?


Options:
A: Inclusion Criteria:

Patient admitted in hospital with a displaced three- or four part proximal humerus fracture of OTA / AO group 11-B2 or 11-C2 (displaced fracture of extra-articular or articular, bifocal type). The subgroups -.1, -.2 and -.3 will be included for both B2 and C2 groups, provided severe displacement: This is defined as a mal-position of at least 45º of angular deviation in valgus or 30º in varus in true frontal projection, regardless of whether the fracture is impacted or not, or less than 50% contact between humeral head and the metaphyseal part of the shaft. The greater or lesser tubercle displaced at least 10 mm.

Exclusion Criteria:

Patient younger than 65 years or older than 85 years, previous history of injury or illness of the injured shoulder, injuries of other parts of the humerus or the contra-lateral upper extremity, alcohol- or drug abuse, dementia, neurological diseases, or severe cardiovascular or lung diseases that would contraindicate surgery. Patients have to understand the Norwegian language and be compliant to rehabilitation and follow-ups.
B: Inclusion Criteria:

1. Displaced 2- or 3-part proximal humerus fractures by the Neer classification.
2. Displaced 4-part proximal humeral fractures by the Neer classification that are deemed amenable to surgical fixation.
3. \> 60 years of age
4. Low energy mechanism of injury
5. Acute fracture (\<3 weeks)

Exclusion Criteria:

1. 4-part proximal humerus fractures that are not deemed amenable to surgical fixation (eg. due to osteopenic bone, thin head or tuberosity fragments); fractures that are better suited to treatment with arthroplasty
2. Isolated greater tuberosity fractures
3. Ipsilateral upper extremity significant injury, concomitant fracture or polytrauma
4. Open fracture
5. Previous ipsilateral shoulder surgery
6. Patients with active worker's compensation claims (due to the expectation of lower rates of success in this patient population)
7. Active joint or systemic infection
8. Patients with convulsive disorders, collagen diseases, and any other conditions that might affect the mobility of the shoulder joint
9. Major medical illness (life expectancy less than 2 years, unacceptably high operative risk, or not medically cleared by preoperative anesthesia consult)
10. Unable to speak or read English/French
11. Psychiatric illness that precludes informed consent
12. Unwilling to be followed for 2 years
C: Inclusion Criteria:

* Age: ≤60 years or younger postmenopausal woman
* 2-fragment-fracture according to AO-classification AO 11-A3
* Signed informed consent
* Patient can read and understand German

Exclusion Criteria:

* Refusal to participate in the study
* Not Independent
* Dementia and/or institutionalized
* Does not understand written and spoken guidance German
* Pathologic fracture or a previous fracture of the same proximal humerus
* Alcoholism or drug addiction, e.g., in the emergency department, breathalyzer indicates blood alcohol concentration of more than 2%
* Other injury to the same upper limb requiring surgery
* Major nerve injury (e.g., complete radial- or axillary nerve palsy)
* Rotator cuff tear arthropathy
* Open fracture
* Multi-trauma or -fractured patient
* Fracture dislocation or head-splitting fracture
* Non-displaced fracture
* Isolated fracture of the major or minor tubercle
* Gross displacement of the fracture fragments (no bony contact between fracture parts or the humeral shaft is in contact with the articular surface)
* Any medical condition that excludes surgical treatment
* Pregnancy
D: 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

Answer: D