Priority 20 from the Broken Bones of the Upper Limb in People over 50

UNCERTAINTY: What is the best way to manage upper limb fractures in people over 50 that have not healed properly?  (JLA PSP Priority 20)
Overall ranking 20
JLA question ID 0093/20
Explanatory note Sometimes an upper limb fracture may not heal properly or may not heal at all, for a variety of reasons. There are several ways we can try to make the fracture heal, either with or without an operation. This question looks to determine what is the best way to manage these fractures and make them heal.

Low-intensity pulsed ultrasound to promote healing of delayed-union and non-union fractures. Interventional procedures guidance [IPG623] Published date: July 2018

Griffin  XL, Costa  ML, Parsons  N, Smith  N. Electromagnetic field stimulation for treating delayed union or non‐union of long bone fractures in adults. Cochrane Database of Systematic Reviews 2011, Issue 4

Health Research Classification System category  Injuries and Accidents
Extra information provided by this PSP
Original uncertainty examples How do we decide when rehab physio hasn't worked and we need to offer late corrective surgery? ~ What happens if I’m managed conservatively but it slips? What’s the risk? ~ What is the best way to treat non union of the humerus? 
Submitted by  3 x Healthcare Professionals, 1 x Patient
PSP information
PSP unique ID 0093
PSP name Broken Bones of the Upper Limb in People over 50 PSP
Total number of uncertainties identified by this PSP. 50  (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop 3 December 2018