Proximal Humerus Fracture (Conservative Management) Patient Information Resource

Purpose

Proximal humerus fractures account for 5-6% of all adult fractures, and are increasingly common in people older than 65 years and have an increasing incidence with an ageing population. Surgical treatment is being increasingly used, contributing to increasing healthcare costs for upper limb fractures. Although the literature provides insufficient evidence to conclude whether surgery produces consistently better outcomes than conservative management. There is no standardised or agreed patient information on surgically or conservatively managed proximal humerus fractures The purpose of this project was to provide an high-quality patient-centred information resource for conservatively managed 1 & 2-part proximal humerus fractures.

Approach

We followed a stepped approach as follows: 1. Review of current available patient information leaflets provided by other NHS trusts/ healthcare organisations, governing bodies, specialist societies, clinical interest groups, and established charities. 2. Review of contemporary evidence base over past five years using Healthcare Databases Advanced Search through CINAHL for non-operative and operative management of proximal humerus fractures. 3. Telephone interview ‘focus group’ of patients diagnosed with either conservative or surgically managed proximal humerus fractures – ‘thematic’ qualitative analysis of results. 4. Discussion with all stakeholders (patients, physiotherapists and surgeons) regarding agreed conservative management milestones post proximal humerus fracture for immobilisation, exercise therapy prescription and return to function. 5. Create a patient resource and ask all stakeholders to review and approve its content.

Outcomes

Results: On review of available patient information resources and literature there was no existing consensus agreement on best practice management of proximal humerus fractures. Agreement was reached on patient information content from review of evidence base, focus group patient feedback, already available resources and discussion with stakeholders regarding conservative milestones regarding period of immobilisation, early mobilisation exercises, return to function and loading / resistance. Draft proximal humerus fracture (conservative management) patient information leaflet to be submitted to PING for trust approval.

Conclusion(s): Most post-operative patient information resources are created unilaterally without involvement of patients and the wider multi-disciplinary team. Our aim to create a resource through co-design with patients, physiotherapists and surgeons was successful.

Cost and savings

No further information. 

Implications

Plan to reconfigure and format leaflet as patient handbook. Plan to design proximal humerus fracture (operative management) patient information leaflet / handbook – including 3 and 4-part fractures. Part of long-term project to review all SGSU post-op protocols, patient information and available resources to patients and therapist on website.

Top three learning points

No further information. 

Funding acknowledgements

Not funded.