The DelPhi trial is a multicenter, single-blinded RCT from 7 Norwegian hospitals. It compares reverse TSA versus ORIF with a PHILOS angular stable plate for severely displaced OTA/AO type-B2 and C2 proximal humeral fractures in patients aged 65-85. The primary question: which operation produces better shoulder function at 2 years?
Plate fixation with angular stable implants was adopted broadly for displaced proximal humeral fractures based on favorable postoperative radiographs, but later data showed up to 30% of patients required secondary procedures. No prior RCT had directly compared reverse TSA against ORIF for these injuries.
This trial gives you a clear decision rule for type-C2 fractures in patients aged 65-85: reverse TSA is the preferred operation, with an 18.7-point Constant score advantage that is both statistically robust and clinically large. For type-B2 fractures, the data trend toward arthroplasty but do not mandate it — patient factors and surgeon experience should drive that conversation.
When counseling patients before reverse TSA, be explicit that internal rotation will not be better than after plate fixation. Every other domain improves, but internal rotation is a known limitation of the construct.
A 2-year follow-up is considered short for an arthroplasty, and the authors have planned 5-year follow-up. Longer-term durability data are still needed before this becomes an unconditional recommendation across all age groups within the study range.
The DelPhi trial is a multicenter, single-blinded RCT from 7 Norwegian hospitals. It compares reverse TSA versus ORIF with a PHILOS angular stable plate for severely displaced OTA/AO type-B2 and C2 proximal humeral fractures in patients aged 65-85. The primary question: which operation produces better shoulder function at 2 years?
Plate fixation with angular stable implants was adopted broadly for displaced proximal humeral fractures based on favorable postoperative radiographs, but later data showed up to 30% of patients required secondary procedures. No prior RCT had directly compared reverse TSA against ORIF for these injuries.
This trial gives you a clear decision rule for type-C2 fractures in patients aged 65-85: reverse TSA is the preferred operation, with an 18.7-point Constant score advantage that is both statistically robust and clinically large. For type-B2 fractures, the data trend toward arthroplasty but do not mandate it — patient factors and surgeon experience should drive that conversation.
When counseling patients before reverse TSA, be explicit that internal rotation will not be better than after plate fixation. Every other domain improves, but internal rotation is a known limitation of the construct.
A 2-year follow-up is considered short for an arthroplasty, and the authors have planned 5-year follow-up. Longer-term durability data are still needed before this becomes an unconditional recommendation across all age groups within the study range.