Please login to view this media
- Talk
- 21/09/2021
- UK
Role of Non-operative Management in Proximal Humerus Fractures - Is the Pendulum Swinging Back to Conservative Management?
Description
In this virtual presentation, Professor Ben Ollivere from Nottingham addresses the current approach to conservative management of proximal humeral fractures, emphasizing a shift in perspective regarding surgical intervention. He discusses his inability to attend the meeting in person due to a positive COVID test, opting instead for a virtual format to stimulate discussion on this critical topic. Professor Ollivere reflects on the challenges faced by shoulder and elbow surgeons when recommending conservative treatments, specifically the discomfort in prescribing slings instead of surgical options, as well as the need for ongoing discussion and consideration of different patient cases.
Key highlights of his talk include:
1. **Historical Context**: The ProFHER trial is referenced, which has shaped recent discourse on the necessity of surgical intervention versus conservative treatment for proximal humeral fractures but is challenged on various grounds.
2. **Clinical Outcomes**: He presents data on minimal clinically important differences (MCIDs) from shoulder outcome measures, indicating that results from both operative and non-operative groups yield similar patient outcomes over five years, thereby questioning the aggressive surgical approach often favored.
3. **Decision-Making Criteria**: Ollivere lays out his thought process for determining when to operate, stressing the importance of the rotator cuff's function and bony anatomy in making a conservative treatment decision.
4. **Contrasting Cases**: He provides case studies illustrating successful conservative management of a stable impacted fracture and a failed conservative treatment scenario due to compromised cuff function, highlighting the individuality of each case.
5. **Future Directions**: Professor Ollivere encourages reconsideration of conservative strategies in proximal humeral fractures, suggesting that both specialists and general trauma surgeons may need to recalibrate their approaches towards treatment classifications.
Concluding, he emphasizes the need for a balanced understanding of when to proceed surgically while advocating for a more liberal application of conservative methods when appropriate.