Broken Bones of the Upper Limb in People over 50

The HUmeral SHaft fracture trial (HUSH)

Addressing priority 7: NIHR research in progress

A humeral shaft fracture is a break in the long bone of the upper arm. It occurs mainly in two groups of individuals; young men and older women, as their bones are more fragile. Currently, the most common treatment (approximately 70%) for these fractures is non-operative -using a cast for two weeks and then a brace until the bone begins to heal properly - although there is large variation in treatments between and in hospitals. The risk of complications is low and the cost also relatively low at £1,100. The disadvantages are that the patient is immobilised for a prolonged period and the cumbersome cast can lead to significant pain and discomfort in some patients. There is also a 20% chance that the break will not heal. This then requires surgery and involves additional costs of approximately £15,500. There appears to be a worldwide trend towards treating these fractures with surgery (rather than a cast and brace), however there is no high quality evidence that this is indeed a better option. Surgery is the more expensive route, and has a higher risk of complication e.g. infection and nerve damage. However there is a better chance of the bone healing successfully and the patient is likely to recover more quickly allowing them to regain their independence sooner. This study aims to directly compare these two methods. 

Randomised Evaluation of rehabilitation after ACute proximal Humerus fracture (the REACH trial)

Addressing priorities in the Broken Bones of the Upper Limb in People over 50 PSP: NIHR research in progress