Does Immobilization Method Make a Difference in Conservative Management of Proximal Humeral Fractures? A Prospective Randomized Trial.

BACKGROUND/OBJECTIVE: The role of conservative treatment in proximal humerus fractures (PHFs) has been increasing with emerging evidence. However, the optimal conservative treatment protocol remains unclear. In particular, the immobilization method-an essential component of conservative management-has not been adequately investigated in the literature. This study aimed to compare the clinical and radiological outcomes of three different immobilization devices that position the shoulder in varying degrees of immobilization. METHODS: This prospective randomized clinical trial included patients diagnosed with PHFs and treated conservatively. Clinical outcome measures included the Subjective Shoulder Value (SSV), Visual Analog Scale (VAS), American Shoulder and Elbow Surgeons (ASES) score, Disabilities of the Arm, Shoulder and Hand (DASH) score, Constant score, and range of motion. The three study groups were compared in terms of clinical and radiological outcomes. RESULTS: Data from 34 patients in Group A (Velpeau bandage), 39 patients in Group B (standard shoulder-arm sling), and 32 patients in Group C (padded shoulder-arm sling) were analyzed. The overall mean age was 60.6 ± 15.9 years, and 67 patients (63.8%) were female. The groups were comparable in baseline characteristics, including age and fracture severity according to Neer classification. No significant differences were observed among the groups in terms of SSV, VAS, ASES, DASH, Constant scores, or range of motion. Radiologically, nonunion occurred in 5 of 120 patients (4.1%), while malunion was detected in 22 of 105 patients (21%). Malunion rates were comparable across the study groups. CONCLUSIONS: The type of immobilization device used in the conservative treatment of PHFs does not appear to influence functional or radiological outcomes. Therefore, the choice of immobilization method may be guided by patient comfort and cost considerations. LEVEL OF EVIDENCE: Level I; Prospective Randomized Controlled Trial.