Prospective Evaluation of the Clinical Profile and Treatment Outcomes of Proximal Humerus Fractures.

Study Overview
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Brief Summary
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With an ageing population, fragility fractures secondary to osteoporosis are on a increasing trend. Proximal humerus fractures are common fractures which account for a significant proportion of these fragility fractures. They significantly affect patients function and independence particularly in the elderly. Currently, treatment options range from conservative treatment with an arm sling to fixation either with plates or intramedullary devices to arthroplasty ranging from a hemiarthroplasty to the latest reverse shoulder arthroplasty. While is there has been a global trend towards surgical treatment for such fractures, there is significant controversy regarding the best treatment with many studies reporting disappointing functional outcomes including residual shoulder pain, limitation in shoulder motion and decreased quality of life regardless of treatment option selected. In this day and age where healthcare cost is a big concern both at the individual patient level but at a government level as well, evaluating the cost effectiveness of treatment becomes essential as well. Currently in Singapore, there have been a significant trend of an increased use of surgical treatment of proximal humerus fractures however we have very little data in our local context not only to evaluate the clinical effectiveness but also the cost effectiveness of surgical treatment in comparison to conservative treatment. The primary aim of the study is To understand the epidemiology and prognostic factors for proximal humerus fractures Incidence Health service utilization clinical and functional outcomes To estimate the relative cost-effectiveness of surgical vs non-surgical treatment pathways for managing patients with proximal humerus fractures. We hypothesize that surgical fixation of the proximal humerus is both clinically and cost effective

Official Title
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Prospective Evaluation of the Clinical Profile and Treatment Outcomes of Proximal Humerus Fractures.

Conditions
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Proximal Humerus Fractures

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age 21 years old and above Radiologically confirmed proximal humerus fracture Within 3 weeks of their injury Exclusion Criteria: Open fracture Mentally incompetent patients Co-morbidities precluding anaesthesia Severe soft tissue compromise Neurovascular compromise Pathological fracture other than osteoporosis Surgery delayed > 3 weeks Pregnancy

Ages Eligible for Study
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Minimum Age: 21 Years
Maximum Age: 110 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Constant Shoulder Score - change over 6 weeks, 3, 6, 12 months | To evaluate the clinical outcomes over time by comparing the change in constant shoulder score over a period of 1 year. The Constant Shoulder Score is used to assess the level of pain and the patient's ability to carry out normal daily activities. Constant score of the unaffected shoulder was also assessed at baseline to compare the function between the two shoulders. | Assessed at baseline, 6 weeks, 3 months, 6 months, 12 months | 
| Oxford Shoulder Score - change over 6 weeks, 3, 6, 12 months | A 12-item patient-report questionnaire developed to evaluate the outcome of shoulder surgery, excluding surgery for instability. The OSS contains two subscales, pain and activities of daily living. Each responses is of a 0-4 scoring format with a higher score representing better function. Hence, the highest possible total score is 48 and a higher score represents a better outcome. | Assessed at baseline, 6 weeks, 3 months, 6 months, 12 months | 
| QuickDASH scoring - change over 6 weeks, 3, 6, 12 months | This score is a subset of 11 items from the 30-item DASH and is a self-reported questionnaire in which the response options are presented as 5-point Likert scales. At least 10 of the 11 items must be completed for a score to be calculated and the scores range from 0 (no disability) to 100 (most severe disability). | Assessed at baseline, 6 weeks, 3 months, 6 months, 12 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| EQ5D-5L - change over 6 weeks, 3, 6, 12 months | EuroQol-5 Dimensions (EQ-5D) consists of 2 dimensions, the EQ-5D descriptive system and the EQ visual analogue scale (EQ VAS). The descriptive system comprises five dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. Each dimension has 5 levels: no problems, slight problems, moderate problems, severe problems and extreme problems. The patient is asked to indicate his/her health state by selecting the most appropriate statement in each of the five dimensions. This decision results in a 1-digit number that expresses the level selected for that dimension. The digits for the five dimensions can be combined into a 5-digit number that describes the patient's health state. The EQ VAS records the patient's self-rated health on a vertical visual analogue scale, where the endpoints are labelled 'The best health you can imagine' and 'The worst health you can imagine'. The VAS will be used as a quantitative measure of health outcome. | Assessed at baseline, 6 weeks, 3 months, 6 months, 12 months | 
| Costing questionnaire | Questionnaire measuring the direct and indirect costs | Assessed at 6 weeks, 3 months, 4.5 months, 6 months |