JSES - 2026-08-21 - Journal Article
Does Immobilization Method Make a Difference in Conservative Management of Proximal Humeral Fractures? A Prospective Randomized Trial.
Sarıkaş DM, Kapıcıoğlu DM, Şahin DK, Bilsel DK
Topics
Key Takeaway
Among three immobilization devices (Velpeau bandage, standard sling, padded sling) for conservatively managed proximal humerus fractures, no significant differences were found in any functional outcome score or malunion rate (21% overall) across 105 evaluable patients.
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Summary
This prospective RCT compared Velpeau bandage, standard shoulder-arm sling, and padded shoulder-arm sling in conservatively managed proximal humerus fractures using SSV, VAS, ASES, DASH, Constant score, and ROM as outcomes. No statistically significant differences were detected across any functional metric among the three groups. Nonunion occurred in 4.1% (5/120) and malunion in 21% (22/105), with comparable rates across groups.
Key Limitation
The absence of a reported follow-up duration prevents assessment of long-term functional equivalence and whether the 21% malunion rate translates to divergent late functional outcomes between groups.
Original Abstract
BACKGROUND/OBJECTIVE
The role of conservative treatment in proximal humerus fractures (PHFs) has been increasing with emerging evidence. However, the optimal conservative treatment protocol remains unclear. In particular, the immobilization method-an essential component of conservative management-has not been adequately investigated in the literature. This study aimed to compare the clinical and radiological outcomes of three different immobilization devices that position the shoulder in varying degrees of immobilization.
METHODS
This prospective randomized clinical trial included patients diagnosed with PHFs and treated conservatively. Clinical outcome measures included the Subjective Shoulder Value (SSV), Visual Analog Scale (VAS), American Shoulder and Elbow Surgeons (ASES) score, Disabilities of the Arm, Shoulder and Hand (DASH) score, Constant score, and range of motion. The three study groups were compared in terms of clinical and radiological outcomes.
RESULTS
Data from 34 patients in Group A (Velpeau bandage), 39 patients in Group B (standard shoulder-arm sling), and 32 patients in Group C (padded shoulder-arm sling) were analyzed. The overall mean age was 60.6 ± 15.9 years, and 67 patients (63.8%) were female. The groups were comparable in baseline characteristics, including age and fracture severity according to Neer classification. No significant differences were observed among the groups in terms of SSV, VAS, ASES, DASH, Constant scores, or range of motion. Radiologically, nonunion occurred in 5 of 120 patients (4.1%), while malunion was detected in 22 of 105 patients (21%). Malunion rates were comparable across the study groups.
CONCLUSIONS
The type of immobilization device used in the conservative treatment of PHFs does not appear to influence functional or radiological outcomes. Therefore, the choice of immobilization method may be guided by patient comfort and cost considerations.
LEVEL OF EVIDENCE
Level I; Prospective Randomized Controlled Trial.