A five-year study led by a Middlesbrough surgeon to determine the best treatment for a broken shoulder – surgery versus no surgery - could lead to financial savings.
Together with researchers from Teesside University and the University of York, Professor Rangan, clinical professor in trauma and orthopaedic surgery at James Cook University Hospital, secured more than £1.25m funding to lead the largest randomised clinical trial on proximal humerus (shoulder) fractures.
The results published in the international Journal of the American Medical Association, found no significant difference between having surgery compared with non-surgical treatment for the more serious types of shoulder fractures and could lead to big NHS savings.
The current treatment for the injury, in people aged over 65, involves putting the arm in a sling or surgery for the more serious fracture, but clinicians were unsure which treatment had the best outcome.
Professor Rangan, the chief investigator on the five-year project in collaboration with clinicians from 32 NHS hospitals, recruited 250 patients into the trial which was sponsored by The School of Health & Social Care at Teesside University.
Patients, who were randomly allocated to surgery or no surgery were followed up for two years with data collected at six, 12 and 24 months.
In total, 231 patients recorded and scored their own progress and experiences after treatment which showed no significant difference in self-assessed function and pain between patients with surgery and those who were allocated no surgery.
Professor Rangan said: “A broken or fractured shoulder can be a particularly painful injury and the function of the arm and shoulder can be considerably compromised - people don’t necessarily regain the independence they had before the injury.
“Some of these fractures clearly need surgery but for the majority it was not clear whether surgery was better than treating the injured arm in a sling followed by physiotherapy.
“Essentially this study was designed to find out whether one treatment was better than the other by evaluating the effectiveness and cost effectiveness of surgical versus non-surgical treatment.
“We know the use of surgery is increasing, but our trial has actually shown no significant difference between the two types of treatment which means we now have the potential to change future clinical treatment of this condition considerably.
“Also to have our paper accepted by JAMA – the Journal of the American Medical Association – is a real accolade.”
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