The PROFHER trial is a pragmatic multicenter RCT from 32 UK hospitals randomizing 250 adults with displaced proximal humerus fractures involving the surgical neck to surgery versus sling immobilization. Both groups received standardized rehabilitation. The trial asks whether surgery produces superior patient-reported outcomes over 2 years.
Surgical rates for proximal humerus fractures were rising sharply before PROFHER, driven by improved implant technology and observational data — without Level I evidence that operating actually helped patients.
This trial provides that Level I answer: for the typical displaced proximal humerus fracture involving the surgical neck, sling immobilization plus rehabilitation matches surgery on every patient-reported measure at every time point over 2 years.
When you see a displaced 2-, 3-, or even 4-part proximal humerus fracture in an adult, the default should be nonsurgical management with structured physiotherapy. Reserve surgery for fractures with specific indications the trial explicitly excluded: open fractures, associated glenohumeral dislocation, severe soft-tissue compromise, or vascular injury.
The equal 9% secondary surgery rate in both groups is worth knowing for consent. Operating does not eliminate the need for further procedures, and it adds inpatient medical risk that nonsurgical care avoids entirely.
The PROFHER trial is a pragmatic multicenter RCT from 32 UK hospitals randomizing 250 adults with displaced proximal humerus fractures involving the surgical neck to surgery versus sling immobilization. Both groups received standardized rehabilitation. The trial asks whether surgery produces superior patient-reported outcomes over 2 years.
Surgical rates for proximal humerus fractures were rising sharply before PROFHER, driven by improved implant technology and observational data — without Level I evidence that operating actually helped patients.
This trial provides that Level I answer: for the typical displaced proximal humerus fracture involving the surgical neck, sling immobilization plus rehabilitation matches surgery on every patient-reported measure at every time point over 2 years.
When you see a displaced 2-, 3-, or even 4-part proximal humerus fracture in an adult, the default should be nonsurgical management with structured physiotherapy. Reserve surgery for fractures with specific indications the trial explicitly excluded: open fractures, associated glenohumeral dislocation, severe soft-tissue compromise, or vascular injury.
The equal 9% secondary surgery rate in both groups is worth knowing for consent. Operating does not eliminate the need for further procedures, and it adds inpatient medical risk that nonsurgical care avoids entirely.