Broken Bones of the Upper Limb in People over 50 (Fractures of the Shoulder, Arm or Wrist)

This PSP looked at broken bones (fractures) in the shoulder (collarbone and shoulder girdle), arm, elbow (humerus), forearm and wrist in people over 50. Fractures involving the upper limb are very common and often have long-lasting effects. Wrist fractures alone affect 100,000 people per year in the UK.

Injuries affecting these parts of the body, either temporarily or permanently, can lead to significant disability. The treatment received is very important in minimising this.

These fractures often occur as a result of low energy injuries such as falls from a standing height. This is often the case with patients over 50. They can also occur as a result of high-energy injuries such as those related to sports, as well as those involved in road traffic accidents.

The treatment for these injuries may involve surgery or not (often called “operative” or “non-operative”). Non-operative treatments include analgesia (pain relief), casting (i.e., placing the affected part into a plaster cast for some weeks) and rehabilitation (such as physiotherapy or occupational therapy). Operative procedures may involve fixing a fracture with the insertion of metal plates and screws, rods passed on the inside of the bone, or even, perhaps, bone replacement using an artificial joint.

There is a lack of research evidence to guide the care and treatment of patients with upper limb fractures. The period immediately after the fracture (initial treatment), the active treatment phase (non-operative or operative) and rehabilitation (restoring limb function and confidence) are three distinct phases in the patient journey. The PSP set out to identify key research questions in each of these areas.

The PSP Top 10 was published in December 2019.

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