***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Previous studies have shown good clinical results in patients with proximal humeral fractures ( PHFs ) treated with locking intramedullary nails or locking plates . Our study compared the clinical and radiographic outcomes in patients with 2- and 3-part surgical neck fractures . METHODS In this prospect i ve , r and omized controlled trial , 72 patients with 2- or 3-part surgical neck PHFs were r and omly assigned to receive fixation with locking intramedullary nails ( nail group ) or locking plates ( plate group ) . The primary outcome was the 12-month Constant-Murley score . The secondary outcomes included the Disabilities of the Arm , Shoulder and H and score , the visual analog scale pain score , the shoulder passive range of motion , the neck-shaft angle , and complication rates . RESULTS There was no significant mean treatment group difference in the Constant-Murley score at 12 months ( 70.3 points for the nail group vs. 71.5 points for the plate group ; P = .750 ) or at individual follow-up assessment s. There were no differences in the 3- , 6- and 12-month Disabilities of the Arm , Shoulder and H and scores , visual analog scale scores , and range of motion , except for the medial rotation at 6 months . The neck-shaft angle was equivalent between the groups at 12 months . There were significant differences over 12 months in total complication rates ( P = .002 ) and reoperation rates ( P = .041 ) . There were no significant differences for the rotator cuff tear rate ( P = .672 ) . CONCLUSION Fixation of PHFs with locking plates or locking intramedullary nails produces similar clinical and radiologic results . Nevertheless , the complication and reoperation rates were higher in the nail group Study Design A prospect i ve cohort study nested in a r and omized controlled trial . Objectives To determine and compare responsiveness and minimal clinical ly important change of the  modified Constant score ( CS )  and the  Oxford Shoulder Score ( OSS ) .  Background The OSS and the CS are commonly used to assess shoulder outcomes . However , few studies have evaluated the measurement properties of the OSS and CS in terms of responsiveness and minimal clinical ly important change . Methods The study included 126 patients who reported having difficulty returning to usual activities 8 to 12 weeks after arthroscopic decompression surgery for subacromial impingement syndrome . The assessment at baseline and at 3 months included the  OSS , the CS  , and the  European Quality of Life-5 Dimensions-3 Level ( EQ-5D-3L ) index . Responsiveness was assessed as follows : by correlation analysis between the change scores of the OSS , CS , and EQ-5D-3L index , and the Patient Global Impression of Change ( PGIC ) scale ; by receiver-operating-characteristic ( ROC ) curve analysis using the PGIC scale as an external anchor ; and by effect-size statistics . Results At 3 months , a follow-up assessment of 112 patients ( 89 % ) was conducted . The change scores of the CS and the OSS were more strongly correlated with the external anchor ( PGIC scale ) than the change score of the EQ-5D-3L index . The areas under the ROC curves exceeded 0.80 for both shoulder scores , with no significant differences between them , and comparable effect-size estimates were observed for the CS and the OSS . Minimal clinical ly important change ROC values were 6 points for the OSS and 11 points for the CS , with upper 95 % cutoff limits of 12 and 22 points , respectively . Conclusion The CS and the OSS were both suitable for assessing improvement after decompression surgery Purpose The aim of this study was to compare the functional outcome , quality of restoration , and complication rate after open reduction and internal fixation ( ORIF ) of displaced or unstable 2- , 3- and 4-part humeral fractures using two different locking plates . Methods The data used in this analysis was prospect ively collected in two large multicentre studies in 15 European Level 1 trauma centres . A total of 318 patients with proximal humeral fractures were treated with ORIF using either the locking proximal humerus plate ( LPHP ) or proximal humeral internal locking system ( PHILOS ) . Outcome measurements included Constant and Neer scores , evaluation of local pain at the fracture site and complications , and radiographic assessment at one year . Results At one year , the mean Constant scores ( relative to the contralateral shoulder ) improved significantly for both groups and were above 80 % for 2- , 3- , and 4-part fractures . A significantly shorter surgical time , less pain at the fracture site , and better functional outcome was achieved by PHILOS-treated patients with 2-part fractures throughout the one-year follow-up month and with 3-part fractures at three months ( p < 0.05 ) . There was no difference between the treatment outcomes for 4-part fractures , and no difference in the complication rates ( p > 0.05 ) . Conclusions PHILOS and LPHP can be considered as useful implants for ORIF of displaced and unstable proximal humeral fractures . There was a slight advantage of the PHILOS system with regard to operative time and functional outcome , especially for the treatment of 2- and 3-part fractures Aims The PROximal Fracture of the Humerus Evaluation by R and omisation ( PROFHER ) r and omised clinical trial compared the operative and non‐operative treatment of adults with a displaced fracture of the proximal humerus involving the surgical neck . The aim of this study was to determine the long‐term treatment effects beyond the two‐year follow‐up . Patients and Methods Of the original 250 trial participants , 176 consented to extended follow‐up and were sent postal question naires at three , four and five years after recruitment to the trial . The Oxford Shoulder Score ( OSS ; the primary outcome ) , EuroQol 5D‐3L ( EQ‐5D‐3L ) , and any recent shoulder operations and fracture data were collected . Statistical and economic analyses , consistent with those of the main trial were applied . Results OSS data were available for 164 , 155 and 149 participants at three , four and five years , respectively . There were no statistically or clinical ly significant differences between operative and non‐operative treatment at each follow‐up point . No participant had secondary shoulder surgery for a new complication . Analyses of EQ‐5D‐3L data showed no significant between‐group differences in quality of life over time . Conclusion These results confirm that the main findings of the PROFHER trial over two years are unchanged at five years OBJECTIVES To compare the outcomes of intramedullary fibular allograft ( IFA ) with locking compression plates ( LCPs ) versus shoulder hemi-arthroplasty ( HA ) in osteoporotic four-part proximal humeral fracture ( PHF ) . METHODS Between January 2010 and December 2012 , totally 60 cases with osteoporotic four-part PHF were enrolled in this study and were r and omly separated into IFA and LCPs group and HA group ( n=30 ) . Additionally , surgery indexes for patients in the two groups , such as Constant-Murley score ( CMS ) , the Disability of Arm , Shoulder and H and ( DASH ) score , individual subject evaluation of the outcomes , plain X-ray , and computer tomography ( CT ) scanning were evaluated and compared . RESULTS CMS , DASH score , activities of daily living ( ADL ) , and range of motion ( ROM ) were statistically higher in the IFA and LCPs group than those in the HA group at the last follow-up , whereas the pain were obviously lower than that in the HA group . Besides , patients in the IFA and LCPs group had higher abduction , external rotation with elbow , strength , and satisfactory rating compared with HA group at the last follow-up . However , one case developed avascular necrosis ( AVN ) , one case encountered screw perforation , and one case experienced varus displacement in the IFA and LCPs group , while there were 2 , 4 , and 2 cases suffered from superficial infection , shoulder stiffness , tuberosity migration in the HA group , respectively . CONCLUSION IFA with LCP have an advantage in functional outcomes than shoulder HA . LEVEL OF EVIDENCE Level II . Prospect i ve cohort study Abstract Background Surgical treatment for displaced proximal humeral fractures is widely used . However , there are very few r and omized controlled studies comparing surgical treatment to conservative treatment , and the evidence is debated . The aim of this study was to describe patients with displaced proximal humeral fractures in a 2-years extension of a r and omized controlled trial , their functional outcome and quality of life .  Material s and methods Patients from a single-center r and omized controlled study of fifty patients aged 60 or above with displaced proximal humeral fracture ( AO/OTA group B2 or C2 ) were r and omized to surgical or conservative treatment . Surgery was performed with an angular stable implant . The main outcome was Constant score at 2-year follow-up . Secondary outcomes were an ASES self- assessment form , the 15D quality of life assessment and radiographs at 2 years . Results A marked improvement of shoulder function and health-related quality of life for both surgically and conservatively treated patients occurs between 6 and 12 months . Almost no change was observed between 1 and 2 year . There were no significant differences between the two treatments at 2-year follow-up . Conclusions In this r and omized controlled trial , surgical treatment proved no better results than conservative treatment for patients with displaced proximal humeral fracture at 2-year follow-up Purpose The purpose of this study was to evaluate the clinical benefit of medial support screws for locking plating of proximal humerus fractures . Methods Seventy-two consecutive patients underwent prospect i ve treatment for proximal humerus fractures with locking plates between October 2007 and September 2008 . Sixty-eight patients accomplished a mean 30.8-month follow-up and were r and omized into two groups : 39 patients were treated with only a locking plate and were classified in the –MSS ( medial support screw ) group , and 29 patients were included in the + MSS group , which were fixed with additional medial support screws .  Clinical and radiological investigations were performed in both groups . Results The fractures united at an average of 13.6 weeks after final surgery . Comparably better shoulder function recovery was achieved in the + MSS group with regard to the Constant shoulder score ( P = 0.01 ) , with the respective excellent and good rates of 79 % and 62 % . Eleven patients developed various complications . A statistical difference ( P = 0.036 ) was observed regarding the failure rate ( 23.1 % in the −MSS group vs. 3.4 % in the + MSS group ) . The early loss of fixation was related to higher age ( P < 0.001 ) and less initial neck-shaft angle ( NSA ) ( P = 0.011 ) of the patients . However , bone mineral density was not significantly associated with loss of fixation ( P = 0.076 ) . Although no difference was found in all types of the fractures between the + MSS and −MSS groups regarding immediate postoperative NSA , we observed a significantly lower final NSA in the −MSS group and greater secondary angle loss in the subgroup of Neer three-part ( P = 0.033 and 0.015 , respectively ) and four-part fractures ( P = 0.043 and 0.027 ) . Conclusions Anatomical reduction can substantially decrease the risk of postoperative failure in locking plating of proximal humerus fractures . Medial support for proximal humerus fractures seems to have no benefits in Neer two-part fractures . However , the additional medial support screws inserted into the medio-inferior region of the humeral head may help to enhance mechanical stability in complex fractures and allow for better maintenance of reduction Abstract Background Fractures of the distal radius are extremely common injuries in adults . However , the optimal management remains controversial . In general , fractures of the distal radius are treated non-operatively if the bone fragments can be held in anatomical alignment by a plaster cast or orthotic . However , if this is not possible , then operative fixation is required . There are several operative options but the two most common in the UK , are Kirschner-wire fixation ( K-wires ) and volar plate fixation using fixed-angle screws ( locking-plates ) . The primary aim of this trial is to determine if there is a difference in the Patient-Reported Wrist Evaluation one year following K-wire fixation versus locking-plate fixation for adult patients with a dorsally-displaced fracture of the distal radius . Methods / design All adult patients with an acute , dorsally-displaced fracture of the distal radius , requiring operative fixation are potentially eligible to take part in this study . A total of 390 consenting patients will be r and omly allocated to either K-wire fixation or locking-plate fixation . The surgery will be performed in trauma units across the UK using the preferred technique of the treating surgeon . Data regarding wrist function , quality of life , complications and costs will be collected at six weeks and three , six and twelve months following the injury . The primary outcome measure will be wrist function with a parallel economic analysis . Discussion This pragmatic , multi-centre trial is due to deliver results in December 2013.Trial registration Current Controlled Trials IS RCT N31379280 UKCRN portfolio ID Fifty patients with complex distal radial fractures treated by primary external fixation were compared with 50 with similar fractures treated by closed medullary pinning . All the patients had Frykman type-VIII injuries . The two groups were similar in regard to demographic characteristics and the method of treatment was r and omly chosen . All the fractures healed within three months . In the external fixation 
    Output:
    
The trend in Sweden is that surgical treatment of PHF is increasing .
Evidence was scarce regarding comparisons of different surgical options for humerus fracture treatment .
The cost of plate fixation of a PHF was at least USD 3900 higher than non-surgical treatment , costs for complications excluded .
There is moderate/low certainty of evidence that surgical treatment of moderately displaced PHF in elderly patients has not been proven to be superior to less costly non-surgical treatment options .